Healthcare Provider Details

I. General information

NPI: 1083832778
Provider Name (Legal Business Name): CAROL YEPEZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N UNIVERSITY DR
PEMBROKE PINES FL
33024-6714
US

IV. Provider business mailing address

350 S MIAMI AVE APT. 2212
MIAMI FL
33130-1909
US

V. Phone/Fax

Practice location:
  • Phone: 917-854-3313
  • Fax:
Mailing address:
  • Phone: 917-854-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH8985
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011753-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: