Provider Demographics
NPI:1700016243
Name:YANCEY, DAVID WILES (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILES
Last Name:YANCEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 28TH AVE N
Mailing Address - Street 2:SUITE H
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4588
Mailing Address - Country:US
Mailing Address - Phone:320-774-1646
Mailing Address - Fax:877-828-6193
Practice Address - Street 1:44 28TH AVE N
Practice Address - Street 2:SUITE H
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4588
Practice Address - Country:US
Practice Address - Phone:320-774-1646
Practice Address - Fax:877-828-6193
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11353111N00000X
MN5845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor