Provider Demographics
NPI:1588668487
Name:YAMAMOTO, CHRISTOPHER SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:YAMAMOTO
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 1:2940 PROFESSIONAL LANE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3300
Mailing Address - Country:US
Mailing Address - Phone:812-232-8580
Mailing Address - Fax:812-234-7518
Practice Address - Street 1:2940 PROFESSIONAL LANE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3300
Practice Address - Country:US
Practice Address - Phone:812-232-8580
Practice Address - Fax:812-232-8580
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091653OtherANTHEM BC & BS UPIN
IN350038796OtherMEDICARE R.R. PROVIDER NU
IN351995451OtherTAX IDENTIFIER NUMBER
IN200107460BMedicaid
IN351995451OtherTAX IDENTIFIER NUMBER
INU64371Medicare UPIN