Provider Demographics
NPI:1255593182
Name:DOUGLAS A. YARASCHUK, P.C.
Entity type:Organization
Organization Name:DOUGLAS A. YARASCHUK, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:YARASCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-387-8122
Mailing Address - Street 1:24801 5 MILE RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3655
Mailing Address - Country:US
Mailing Address - Phone:313-387-8122
Mailing Address - Fax:313-387-8123
Practice Address - Street 1:24801 5 MILE RD
Practice Address - Street 2:SUITE 22
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3655
Practice Address - Country:US
Practice Address - Phone:313-387-8122
Practice Address - Fax:313-387-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP19720Medicare PIN