Provider Demographics
NPI:1679656482
Name:YAEGER, DAVID B (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:YAEGER
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:W3198 HWY 60
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925
Mailing Address - Country:US
Mailing Address - Phone:608-347-3569
Mailing Address - Fax:
Practice Address - Street 1:214 E. SEWARD STREET
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955
Practice Address - Country:US
Practice Address - Phone:608-635-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3896-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38942300Medicaid
WI38942300Medicaid