=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518394394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YAMADA CHIROPRACTIC CLINIC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2013
-----------------------------------------------------
Last Update Date | 10/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 S PROSPECT ST
-----------------------------------------------------
City | ROSELLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60172-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-307-1150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 S PROSPECT ST
-----------------------------------------------------
City | ROSELLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60172-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-307-1150
-----------------------------------------------------
Fax | 630-307-3536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. YOUKO YAMADA
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 630-307-1150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 038012306
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------