Provider Demographics
NPI:1265649909
Name:OYOUNG, MICHAEL T (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:OYOUNG
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 1:1530 WEBSTER ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4994
Mailing Address - Country:US
Mailing Address - Phone:707-422-4222
Mailing Address - Fax:707-422-4474
Practice Address - Street 1:1530 WEBSTER ST
Practice Address - Street 2:SUITE E
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4994
Practice Address - Country:US
Practice Address - Phone:707-422-4222
Practice Address - Fax:707-422-4474
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
68-0096837OtherEIN
CADC0147120Medicare ID - Type Unspecified