Provider Demographics
NPI:1336509330
Name:SHED LIGHT, PC
Entity Type:Organization
Organization Name:SHED LIGHT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:CARLENE
Authorized Official - Last Name:YURICHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-921-2030
Mailing Address - Street 1:2611 HAMPDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1010
Mailing Address - Country:US
Mailing Address - Phone:610-921-2030
Mailing Address - Fax:
Practice Address - Street 1:2611 HAMPDEN BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1010
Practice Address - Country:US
Practice Address - Phone:610-921-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty