Healthcare Provider Details

I. General information

NPI: 1700016243
Provider Name (Legal Business Name): DAVID WILES YANCEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 28TH AVE N SUITE H
SAINT CLOUD MN
56303-4588
US

IV. Provider business mailing address

44 28TH AVE N SUITE H
SAINT CLOUD MN
56303-4588
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-1646
  • Fax: 877-828-6193
Mailing address:
  • Phone: 320-774-1646
  • Fax: 877-828-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11353
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5845
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: