Provider Demographics
NPI:1265589691
Name:YAMAMOTO, SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:YAMAMOTO
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 1:2517 N GREAT WESTERN DR
Mailing Address - Street 2:#L
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2597
Mailing Address - Country:US
Mailing Address - Phone:928-778-1190
Mailing Address - Fax:928-759-8107
Practice Address - Street 1:2517 N GREAT WESTERN DR
Practice Address - Street 2:#L
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2597
Practice Address - Country:US
Practice Address - Phone:928-778-1190
Practice Address - Fax:928-759-8107
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ00318Medicare PIN