Healthcare Provider Details

I. General information

NPI: 1467540880
Provider Name (Legal Business Name): JAMES JOSEPH YEATES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 LASKIN RD SUITE 103
VIRGINIA BEACH VA
23451-6302
US

IV. Provider business mailing address

1023 LASKIN RD SUITE 103
VIRGINIA BEACH VA
23451-6302
US

V. Phone/Fax

Practice location:
  • Phone: 757-227-5465
  • Fax: 757-227-5725
Mailing address:
  • Phone: 757-227-5465
  • Fax: 757-227-5725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001049
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: