Provider Demographics
NPI:1720367667
Name:YODER CHIROPRACTIC CENTER P.S.
Entity Type:Organization
Organization Name:YODER CHIROPRACTIC CENTER P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-254-0994
Mailing Address - Street 1:16111 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9033
Mailing Address - Country:US
Mailing Address - Phone:360-254-0994
Mailing Address - Fax:360-254-0930
Practice Address - Street 1:16111 SE MCGILLIVRAY BLVD
Practice Address - Street 2:STE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9033
Practice Address - Country:US
Practice Address - Phone:360-254-0994
Practice Address - Fax:360-254-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty