Provider Demographics
NPI:1609125632
Name:KLYKOV, YAROSLAV IGOREVICH (LMP)
Entity Type:Individual
Prefix:
First Name:YAROSLAV
Middle Name:IGOREVICH
Last Name:KLYKOV
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 MEADOWBROOK CT APT 327
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7377
Mailing Address - Country:US
Mailing Address - Phone:360-966-6232
Mailing Address - Fax:
Practice Address - Street 1:375 MEADOWBROOK CT APT 327
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7377
Practice Address - Country:US
Practice Address - Phone:360-527-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60235982111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician