Healthcare Provider Details

I. General information

NPI: 1376521047
Provider Name (Legal Business Name): JEFFRY SCOTT YODER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 N MERIDIAN ST SUITE C
INDIANAPOLIS IN
46202-1300
US

IV. Provider business mailing address

2162 N MERIDIAN ST SUITE C
INDIANAPOLIS IN
46202-1300
US

V. Phone/Fax

Practice location:
  • Phone: 317-923-4894
  • Fax: 317-924-4029
Mailing address:
  • Phone: 317-923-4894
  • Fax: 317-924-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001769A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: