Provider Demographics
NPI:1114260452
Name:YOUNG, KASSIE JEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KASSIE
Middle Name:JEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:JEAN
Other - Last Name:RUDOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2911 CROSSING CT SUITE 101
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6108
Mailing Address - Country:US
Mailing Address - Phone:217-359-0550
Mailing Address - Fax:217-359-0808
Practice Address - Street 1:2911 CROSSING CT SUITE 101
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6108
Practice Address - Country:US
Practice Address - Phone:217-359-0550
Practice Address - Fax:217-359-0808
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012380111N00000X
IL038.012380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor