Provider Demographics
NPI:1740200195
Name:YAN, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:YAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 WESTPOINT PARKWAY
Mailing Address - Street 2:SUITE 750
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-250-9072
Mailing Address - Fax:440-250-9105
Practice Address - Street 1:853 WESTPOINT PKWY
Practice Address - Street 2:SUITE 750
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1532
Practice Address - Country:US
Practice Address - Phone:440-250-9072
Practice Address - Fax:440-250-9105
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2413687Medicaid
OH2413687Medicaid