Provider Demographics
NPI:1831230309
Name:YANULAVICH, EDWARD ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:YANULAVICH
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 1:727 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1542
Mailing Address - Country:US
Mailing Address - Phone:570-344-6073
Mailing Address - Fax:570-348-5099
Practice Address - Street 1:727 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1542
Practice Address - Country:US
Practice Address - Phone:570-344-6073
Practice Address - Fax:570-348-5099
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002053-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYA156702Medicare ID - Type Unspecified