Provider Demographics
NPI:1780198630
Name:BRIAN YODICE, D.C., P.C.
Entity Type:Organization
Organization Name:BRIAN YODICE, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YODICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-991-0438
Mailing Address - Street 1:12051 W ALAMEDA PKWY # D4
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2701
Mailing Address - Country:US
Mailing Address - Phone:303-985-5540
Mailing Address - Fax:303-985-5676
Practice Address - Street 1:12051 W ALAMEDA PKWY # D4
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2701
Practice Address - Country:US
Practice Address - Phone:303-985-5540
Practice Address - Fax:303-985-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX009553OtherLICENSE