Provider Demographics
NPI:1891401576
Name:GYERYEN, YELIZAVETA V (DC)
Entity Type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:V
Last Name:GYERYEN
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:PO BOX 578744
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8744
Mailing Address - Country:US
Mailing Address - Phone:209-549-6812
Mailing Address - Fax:
Practice Address - Street 1:5910 CLARK RD STE Q
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4860
Practice Address - Country:US
Practice Address - Phone:530-877-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor