Provider Demographics
NPI:1003037987
Name:YOUNG, THRESA M (DC)
Entity Type:Individual
Prefix:DR
First Name:THRESA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 325
Mailing Address - Street 2:201 SOUTH KIBLER ST
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44854
Mailing Address - Country:US
Mailing Address - Phone:419-492-2129
Mailing Address - Fax:419-492-3344
Practice Address - Street 1:201 S KIBLER ST
Practice Address - Street 2:
Practice Address - City:NEW WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:44854
Practice Address - Country:US
Practice Address - Phone:419-492-2129
Practice Address - Fax:419-492-3344
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000131591OtherANTHEM
OH0867736Medicaid
OH0867736Medicaid
0706991Medicare PIN