Provider Demographics
NPI:1720001654
Name:YODER, TERRY E (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:E
Last Name:YODER
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 1:16211 S KIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9437
Mailing Address - Country:US
Mailing Address - Phone:816-322-2644
Mailing Address - Fax:
Practice Address - Street 1:16211 S KIDWELL RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MO
Practice Address - Zip Code:64034-9437
Practice Address - Country:US
Practice Address - Phone:816-322-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL897068Medicare ID - Type Unspecified
MOL890000Medicare UPIN