Provider Demographics
NPI:1003933425
Name:YOUNG, LARRY JOE (DC)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOE
Last Name:YOUNG
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 1:4201 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-1737
Mailing Address - Country:US
Mailing Address - Phone:806-763-8361
Mailing Address - Fax:806-762-6383
Practice Address - Street 1:4201 AVENUE R
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-1737
Practice Address - Country:US
Practice Address - Phone:806-763-8361
Practice Address - Fax:806-762-6383
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3067OtherCHIROPRACTIC LICENSE
TX3067OtherCHIROPRACTIC LICENSE
TX3067OtherCHIROPRACTIC LICENSE
U14137Medicare UPIN