Active NPI
Ian Yetzke, DC
- Chiropractor
- Riverview, FL
National Provider Identifier
1649094335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 14545
- Practice address
- 10629 Big Bend Rd Ste 224
Riverview, FL 33579-7176 - Phone
- (813) 590-7799
- NPI assigned
- Nov 11, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 14545 | FL | Primary |
Addresses
Primary practice location
10629 Big Bend Rd Ste 224
Riverview, FL 33579-7176
Mailing address
4950 W Prescott St
Tampa, FL 33616-2903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14545 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1649094335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4950 W PRESCOTT ST",
"city": "TAMPA",
"state": "FL",
"postal_code": "336162903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10629 BIG BEND RD STE 224",
"city": "RIVERVIEW",
"state": "FL",
"postal_code": "335797176",
"telephone_number": "813-590-7799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YETZKE",
"first_name": "IAN",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-11-11",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "14545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.