Provider Demographics
NPI:1225116775
Name:DVORA, YANIV J (DC)
Entity Type:Individual
Prefix:
First Name:YANIV
Middle Name:J
Last Name:DVORA
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 1:2072 TAPO ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3441
Mailing Address - Country:US
Mailing Address - Phone:805-584-1114
Mailing Address - Fax:805-584-3102
Practice Address - Street 1:2072 TAPO ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3441
Practice Address - Country:US
Practice Address - Phone:805-584-1114
Practice Address - Fax:805-584-3102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC27909AMedicare ID - Type Unspecified
CAV05913Medicare UPIN