Provider Demographics
NPI:1275611642
Name:YODICE, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:YODICE
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 1:12051 W ALAMEDA PKWY # D4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2701
Mailing Address - Country:US
Mailing Address - Phone:303-985-5540
Mailing Address - Fax:985-985-5676
Practice Address - Street 1:12051 W ALAMEDA PKWY # D4
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2701
Practice Address - Country:US
Practice Address - Phone:303-985-5540
Practice Address - Fax:303-985-5676
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
D78350Medicare UPIN
NYXID972Medicare ID - Type Unspecified