Provider Demographics
NPI:1417229048
Name:YOUNG, BROOK (DC)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:
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 1:710 NE 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3155
Mailing Address - Country:US
Mailing Address - Phone:541-513-5798
Mailing Address - Fax:
Practice Address - Street 1:15814 NE 182ND AVE
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606-9701
Practice Address - Country:US
Practice Address - Phone:541-513-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5011111N00000X
WACH 60440315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor