Provider Demographics
NPI:1417959933
Name:YODER, JOLENE E (DC)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:E
Last Name:YODER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WHEATLAND DR
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-5667
Mailing Address - Country:US
Mailing Address - Phone:620-663-1791
Mailing Address - Fax:620-664-5073
Practice Address - Street 1:1305 WHEATLAND DR
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-5667
Practice Address - Country:US
Practice Address - Phone:620-663-1791
Practice Address - Fax:620-664-5073
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC3421111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST43818Medicare UPIN