Provider Demographics
NPI:1366631657
Name:YAN, DAN MIN (DC)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:MIN
Last Name:YAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:MIN
Other - Last Name:YAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:7505 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2453
Mailing Address - Country:US
Mailing Address - Phone:503-888-8883
Mailing Address - Fax:
Practice Address - Street 1:7505 S.E. POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2453
Practice Address - Country:US
Practice Address - Phone:503-888-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273124111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR105536Medicare PIN