Provider Demographics
NPI:1841388873
Name:MARINKOVICH, YVONNE (DC)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:MARINKOVICH
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 1:1851 N GAFFEY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1258
Mailing Address - Country:US
Mailing Address - Phone:310-548-3172
Mailing Address - Fax:310-548-3251
Practice Address - Street 1:1851 N GAFFEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-1258
Practice Address - Country:US
Practice Address - Phone:310-548-3172
Practice Address - Fax:310-548-3251
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330031105Medicare UPIN