Provider Demographics
NPI:1538367917
Name:YEPSEN CHIROPRACTIC INC
Entity type:Organization
Organization Name:YEPSEN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:YEPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-339-2444
Mailing Address - Street 1:108 SOUTH MCCOY STREET
Mailing Address - Street 2:PO BOX 552
Mailing Address - City:GRANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61326
Mailing Address - Country:US
Mailing Address - Phone:815-339-2444
Mailing Address - Fax:
Practice Address - Street 1:108 SOUTH MCCOY STREET
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61326
Practice Address - Country:US
Practice Address - Phone:815-339-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL989360Medicare PIN