MEDICARE: YENSID JR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08001756A	IN

General Provider Information

NPI Number	:	1295110989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YENSID JR LLC

Provider Business Mailing Address
First Line	:	3027 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	574-259-9355
Fax Number	:	574-288-2737

Provider Business Practice Location Address
First Line	:	3027 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	574-259-9355
Fax Number	:	574-288-2737

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LISA A MEYERS
Credential	:	DC
Telephone Number	:	574-259-9355

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	07/23/2015

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Directions to “YENSID JR LLC ” Practice Location

Language	Start Address	Practice Location

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