Provider Demographics
NPI:1932658713
Name:YATES, KEVIN JAMES (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:YATES
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 1:901 E OAK ST STE B
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5837
Mailing Address - Country:US
Mailing Address - Phone:407-933-7755
Mailing Address - Fax:407-926-0577
Practice Address - Street 1:5118 SAINT MARIE AVE
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812-1067
Practice Address - Country:US
Practice Address - Phone:407-791-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor