Healthcare Provider Details

I. General information

NPI: 1073217618
Provider Name (Legal Business Name): RYLEE YORGASON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W MAIN ST
REXBURG ID
83440-1830
US

IV. Provider business mailing address

430 W 2ND S APT 14204
REXBURG ID
83440-1362
US

V. Phone/Fax

Practice location:
  • Phone: 208-652-2225
  • Fax:
Mailing address:
  • Phone: 307-851-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-2280
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: