Provider Demographics
NPI:1821620410
Name:YODER, DUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
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 1:10528 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1268
Mailing Address - Country:US
Mailing Address - Phone:260-338-1700
Mailing Address - Fax:260-338-1781
Practice Address - Street 1:10528 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1268
Practice Address - Country:US
Practice Address - Phone:260-338-1700
Practice Address - Fax:260-338-1781
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003145A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor