Provider Demographics
NPI:1417102732
Name:YADETO, DEKEBO MEBRAT (DC)
Entity Type:Individual
Prefix:DR
First Name:DEKEBO
Middle Name:MEBRAT
Last Name:YADETO
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 1:10612 SE 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2701
Mailing Address - Country:US
Mailing Address - Phone:503-915-3427
Mailing Address - Fax:503-342-6217
Practice Address - Street 1:10612 SE 59TH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2701
Practice Address - Country:US
Practice Address - Phone:503-915-3427
Practice Address - Fax:503-342-6217
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3890111N00000X
ORP-8980212278E1000X
OR15-2418253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducationalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1811234230OtherOTHER NPI