Provider Demographics
NPI:1376521047
Name:YODER, JEFFRY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:SCOTT
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 1:2162 N MERIDIAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1300
Mailing Address - Country:US
Mailing Address - Phone:317-923-4894
Mailing Address - Fax:317-924-4029
Practice Address - Street 1:2162 N MERIDIAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1300
Practice Address - Country:US
Practice Address - Phone:317-923-4894
Practice Address - Fax:317-924-4029
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001769A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN171600AMedicare PIN