Provider Demographics
NPI:1457656803
Name:YENCHIK, JOSEPH PAUL (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PAUL
Last Name:YENCHIK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4309
Mailing Address - Country:US
Mailing Address - Phone:541-231-1035
Mailing Address - Fax:541-265-7820
Practice Address - Street 1:985 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4309
Practice Address - Country:US
Practice Address - Phone:541-231-1035
Practice Address - Fax:541-265-7820
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17715171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor