Provider Demographics
NPI:1083832778
Name:YEPEZ, CAROL (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:YEPEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S MIAMI AVE
Mailing Address - Street 2:APT. 2212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1909
Mailing Address - Country:US
Mailing Address - Phone:917-854-3313
Mailing Address - Fax:
Practice Address - Street 1:170 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6714
Practice Address - Country:US
Practice Address - Phone:917-854-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8985111N00000X
NYX011753-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016473600Medicaid
FL016473600Medicaid