Provider Demographics
NPI:1043435613
Name:YEOMANS EDINGER CHIROPRACTIC CENTER SC
Entity type:Organization
Organization Name:YEOMANS EDINGER CHIROPRACTIC CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEOMANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-748-3644
Mailing Address - Street 1:404 EUREKA ST
Mailing Address - Street 2:P O BOX 263
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1192
Mailing Address - Country:US
Mailing Address - Phone:920-748-3644
Mailing Address - Fax:
Practice Address - Street 1:404 EUREKA ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1192
Practice Address - Country:US
Practice Address - Phone:920-748-3644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350023259OtherSTEVE YEOMANS RR
WI389493699OtherSTEVE YEOMANS NETWORK
WI38762100Medicaid
WI38901800Medicaid
WI392727720OtherMARK EDINGER NETWORK
WI389493699OtherSTEVE YEOMANS NETWORK
WI=========013OtherMARK EDINGER BCBS
WIT63725Medicare UPIN
WI=========013OtherMARK EDINGER BCBS
WI000170345Medicare ID - Type UnspecifiedSTEVE YEOMANS
WI000270345Medicare ID - Type UnspecifiedMARK EDINGER