Provider Demographics
NPI:1710911714
Name:YADLOSKY, JEFFREY TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TODD
Last Name:YADLOSKY
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 1:542 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1841
Mailing Address - Country:US
Mailing Address - Phone:570-253-0776
Mailing Address - Fax:570-253-3849
Practice Address - Street 1:542 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1841
Practice Address - Country:US
Practice Address - Phone:570-253-0776
Practice Address - Fax:570-253-3849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006304-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001457156OtherGROUP ID HIGHMARK
PA001456104OtherHIGHMARK BLUE SHIELD
PA1456104OtherBLUE CROSS/BLUE SHIELD
PA1456104OtherBLUE CROSS/BLUE SHIELD
PAU94487Medicare UPIN