Healthcare Provider Details

I. General information

NPI: 1093828089
Provider Name (Legal Business Name): T SCOTT YODER DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18525 TORRENCE AVE STE F3
LANSING IL
60438-2891
US

IV. Provider business mailing address

18525 TORRENCE AVE STE F3
LANSING IL
60438-2891
US

V. Phone/Fax

Practice location:
  • Phone: 708-418-5505
  • Fax: 708-418-5531
Mailing address:
  • Phone: 708-418-5505
  • Fax: 708-418-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: