Provider Demographics
NPI:1437285632
Name:YOUNG, KERRY VINCE (DC)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:VINCE
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 1:1846 1ST ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4415
Mailing Address - Country:US
Mailing Address - Phone:208-528-7400
Mailing Address - Fax:
Practice Address - Street 1:1846 1ST ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4415
Practice Address - Country:US
Practice Address - Phone:208-528-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1673374Medicare ID - Type Unspecified
IDU17267Medicare UPIN