Healthcare Provider Details

I. General information

NPI: 1548264484
Provider Name (Legal Business Name): THOMAS P. YANKUSH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BOARDMAN CANFIELD ROAD SUITE A1
BOARDMAN OH
44512-4374
US

IV. Provider business mailing address

725 BOARDMAN CANFIELD ROAD SUITE A1
BOARDMAN OH
44512-4374
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-0151
  • Fax: 330-726-6540
Mailing address:
  • Phone: 330-726-0151
  • Fax: 330-726-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number869
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: