MEDICARE: DOUGLAS A. YARASCHUK

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	2301004938	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11464341	OTHER	MI	CAQH

General Provider Information

NPI Number	:	1912907296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS A. YARASCHUK

Provider Business Mailing Address
First Line	:	24801 5 MILE RD STE 22
Second Line	:
City	:	REDFORD
State	:	MI
Zip	:	48239-3654
Country	:	US
Telephone Number	:	313-387-8122
Fax Number	:	313-387-8123

Provider Business Practice Location Address
First Line	:	24801 5 MILE RD STE 22
Second Line	:
City	:	REDFORD
State	:	MI
Zip	:	48239-3654
Country	:	US
Telephone Number	:	313-387-8122
Fax Number	:	313-387-8123

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/17/2008

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