Provider Demographics
NPI:1225253347
Name:DEYOUNG, K A (DC)
Entity Type:Individual
Prefix:DR
First Name:K
Middle Name:A
Last Name:DEYOUNG
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 1:1218 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2927
Mailing Address - Country:US
Mailing Address - Phone:703-684-0260
Mailing Address - Fax:703-684-0262
Practice Address - Street 1:1218 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2927
Practice Address - Country:US
Practice Address - Phone:703-684-0260
Practice Address - Fax:703-684-0262
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA237347OtherANTHEM BCBS OF VA
VA237347OtherANTHEM BCBS OF VA
T73423Medicare UPIN