Healthcare Provider Details

I. General information

NPI: 1528042694
Provider Name (Legal Business Name): THERESA S YASSES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 BATAVIA CITY CTR
BATAVIA NY
14020-2146
US

IV. Provider business mailing address

46 BATAVIA CITY CTR
BATAVIA NY
14020-2146
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-1619
  • Fax: 585-344-1635
Mailing address:
  • Phone: 585-344-1619
  • Fax: 585-344-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006889-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: