Provider Demographics
NPI:1083925150
Name:YOUNG, LUKE RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:RYAN
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 1:414 BAXTER AVE
Mailing Address - Street 2:SUITE 256
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1198
Mailing Address - Country:US
Mailing Address - Phone:803-687-0773
Mailing Address - Fax:
Practice Address - Street 1:414 BAXTER AVE
Practice Address - Street 2:SUITE 256
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1198
Practice Address - Country:US
Practice Address - Phone:803-687-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5310111N00000X
SC3542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor