Provider Demographics
NPI:1730152299
Name:YEPSEN, ALAN ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROBERT
Last Name:YEPSEN
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 1:108 S MCCOY STREET
Mailing Address - Street 2:
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 S 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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350037407OtherRR MEDICARE
IL8077410OtherCIGNA
IL07882001OtherBLUE CROSS/BLUE SHEILD
IL989360Medicare ID - Type Unspecified
ILU09496Medicare UPIN