Provider Demographics
NPI:1528042694
Name:YASSES, THERESA S (DC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:S
Last Name:YASSES
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 1:46 BATAVIA CITY CTR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2146
Mailing Address - Country:US
Mailing Address - Phone:585-344-1619
Mailing Address - Fax:585-344-1635
Practice Address - Street 1:46 BATAVIA CITY CTR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2146
Practice Address - Country:US
Practice Address - Phone:585-344-1619
Practice Address - Fax:585-344-1635
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006889-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC-007262-LOtherPA LICENSE
NY100227ANOtherPREFERRED CARE
NY12150647OtherMULTIPLAN
NY16142292401OtherPRISM
NY5804106OtherGHI
NYC06889-2OtherWORKER'S COMPENSATION #
NYX006889-1OtherNEW YORK LICENSE
NY16142292401OtherPRISM
NY100227ANOtherPREFERRED CARE
NYC06889-2OtherWORKER'S COMPENSATION #