=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568581841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ALLAN YEARLING DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12940 HARRIET AVE S STE 240
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-2680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-707-8588
-----------------------------------------------------
Fax | 952-707-8598
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16520 INGUADONA BEACH CIR SW
-----------------------------------------------------
City | PRIOR LAKE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55372-2368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-447-8572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2462
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------