Provider Demographics
NPI:1235297011
Name:YOUNG, RICHARD GRANT (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GRANT
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 1:2813 ALTA MERE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4112
Mailing Address - Country:US
Mailing Address - Phone:817-735-1121
Mailing Address - Fax:817-735-1163
Practice Address - Street 1:2813 ALTA MERE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4112
Practice Address - Country:US
Practice Address - Phone:817-735-1121
Practice Address - Fax:817-735-1163
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4312OtherLICENSE NUMBER
TX601593Medicare ID - Type Unspecified