Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | IL |
NPI | 1093828089 |
---|---|
Provider Name | Dr. T Scott Yoder |
First Address | Lansing, IL 60438-2891 |
Second Address | Lansing, IL 60438-2891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21622585 | BLUE CROSS/ BLUE SHIELD (01) | IL |
U46606 | (02) | IL |