Provider Demographics
NPI:1073217618
Name:YORGASON, RYLEE (DC)
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:YORGASON
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 1:430 W 2ND S APT 14204
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1362
Mailing Address - Country:US
Mailing Address - Phone:307-851-1934
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1830
Practice Address - Country:US
Practice Address - Phone:208-652-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-2280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor