Provider Demographics
NPI:1053597971
Name:YODER, DERRICK PETER (DC)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:PETER
Last Name:YODER
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 1:7855 S EMERSON AVE
Mailing Address - Street 2:STE Q
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8669
Mailing Address - Country:US
Mailing Address - Phone:317-884-2636
Mailing Address - Fax:
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:STE Q
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8669
Practice Address - Country:US
Practice Address - Phone:317-884-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002374A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor