Provider Demographics
NPI:1912965203
Name:YODER, LEA (DC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 S WILLOW DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5170
Mailing Address - Country:US
Mailing Address - Phone:303-773-9798
Mailing Address - Fax:303-773-9865
Practice Address - Street 1:5950 S WILLOW DR
Practice Address - Street 2:SUITE 205
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5170
Practice Address - Country:US
Practice Address - Phone:303-773-9798
Practice Address - Fax:303-773-9865
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46683Medicare UPIN