Provider Demographics
NPI:1952498123
Name:YAEGER, GARY DENNIS (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DENNIS
Last Name:YAEGER
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OAK RD
Mailing Address - Street 2:STE. 120
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7746
Mailing Address - Country:US
Mailing Address - Phone:925-947-0188
Mailing Address - Fax:925-262-8465
Practice Address - Street 1:3100 OAK RD
Practice Address - Street 2:STE. 120
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7746
Practice Address - Country:US
Practice Address - Phone:925-947-0188
Practice Address - Fax:925-262-8465
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0234341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0234341Medicare UPIN