Provider Demographics
NPI:1043614308
Name:YOUNG, SCOTT TAYLOR (DC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:TAYLOR
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 1:905 HERNDON PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-437-8195
Mailing Address - Fax:703-437-2404
Practice Address - Street 1:905 HERNDON PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-437-8195
Practice Address - Fax:703-437-2404
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor