Healthcare Provider Details

I. General information

NPI: 1306225925
Provider Name (Legal Business Name): YEVGENIYA YANAYEVA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8102 SPRING VALLEY RD
DALLAS TX
75240-3829
US

IV. Provider business mailing address

8102 SPRING VALLEY RD
DALLAS TX
75240-3829
US

V. Phone/Fax

Practice location:
  • Phone: 972-247-7246
  • Fax:
Mailing address:
  • Phone: 972-247-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: