Provider Demographics
NPI:1093828089
Name:YODER, T SCOTT (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:T
Middle Name:SCOTT
Last Name:YODER
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18525 TORRENCE AVE STE F3
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2891
Mailing Address - Country:US
Mailing Address - Phone:708-418-5505
Mailing Address - Fax:708-418-5531
Practice Address - Street 1:18525 TORRENCE AVE STE F3
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2891
Practice Address - Country:US
Practice Address - Phone:708-418-5505
Practice Address - Fax:708-418-5531
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622585OtherBLUE CROSS/ BLUE SHIELD
ILK13548Medicare ID - Type Unspecified
IL21622585OtherBLUE CROSS/ BLUE SHIELD