Provider Demographics
NPI:1114143724
Name:YODER, PAUL (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:YODER
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 1:106 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032-9037
Mailing Address - Country:US
Mailing Address - Phone:717-896-3385
Mailing Address - Fax:
Practice Address - Street 1:106 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-9037
Practice Address - Country:US
Practice Address - Phone:717-896-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002658-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU01383Medicare UPIN
PA435526Medicare PIN