Provider Demographics
NPI:1497082580
Name:YAMAMOTO CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:YAMAMOTO CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-778-1190
Mailing Address - Street 1:2517 N GREAT WESTERN DR STE L
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2597
Mailing Address - Country:US
Mailing Address - Phone:928-778-1190
Mailing Address - Fax:928-759-8107
Practice Address - Street 1:2517 N GREAT WESTERN DR #L
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2597
Practice Address - Country:US
Practice Address - Phone:928-778-1190
Practice Address - Fax:928-759-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty