Provider Demographics
NPI:1063443364
Name:YADON, WILLIAM R (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:YADON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 TERRA CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4994
Mailing Address - Country:US
Mailing Address - Phone:502-410-0191
Mailing Address - Fax:502-890-5177
Practice Address - Street 1:2301 TERRA CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4994
Practice Address - Country:US
Practice Address - Phone:502-410-0191
Practice Address - Fax:502-890-5177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5059111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100211280Medicaid
KYK047580Medicare PIN