Provider Demographics
NPI:1457519670
Name:YAMADA CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:YAMADA CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:YOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-899-9436
Mailing Address - Street 1:116 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2049
Mailing Address - Country:US
Mailing Address - Phone:630-307-1150
Mailing Address - Fax:630-307-3536
Practice Address - Street 1:116 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2049
Practice Address - Country:US
Practice Address - Phone:630-307-1150
Practice Address - Fax:630-307-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19304Medicare UPIN
IL212015Medicare PIN