MEDICARE: DR. JAMES MICHAEL YADANZA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0009601	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110363AN	OTHER	NY	PREFERRED CARE PROVIDER N
2	7087371	OTHER	NY	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1568474708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL YADANZA D.C.

Provider Business Mailing Address
First Line	:	11885 W MAIN ST
Second Line	:
City	:	WOLCOTT
State	:	NY
Zip	:	14590-1027
Country	:	US
Telephone Number	:	315-594-9400
Fax Number	:	315-594-9613

Provider Business Practice Location Address
First Line	:	11885 W MAIN ST
Second Line	:
City	:	WOLCOTT
State	:	NY
Zip	:	14590-1027
Country	:	US
Telephone Number	:	315-594-9400
Fax Number	:	315-594-9613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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