MEDICARE: DIRK YASKO

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	1869	AL

General Provider Information

NPI Number	:	1801877840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIRK YASKO

Provider Business Mailing Address
First Line	:	4735 NORREL DR
Second Line	:	SUITE 5
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-2679
Country	:	US
Telephone Number	:	205-655-0123
Fax Number	:	205-655-0466

Provider Business Practice Location Address
First Line	:	4735 NORREL DR
Second Line	:	SUITE 5
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-2679
Country	:	US
Telephone Number	:	205-655-0123
Fax Number	:	205-655-0466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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Directions to “ DIRK YASKO ” Practice Location

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