Provider Demographics
NPI:1457655052
Name:YOUNG, ANGELA (DC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:YOUNG
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 1:2404 S ORCHARD ST
Mailing Address - Street 2:STE 800
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6725
Mailing Address - Country:US
Mailing Address - Phone:208-345-2222
Mailing Address - Fax:208-620-2215
Practice Address - Street 1:2404 S ORCHARD ST
Practice Address - Street 2:STE 800
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6725
Practice Address - Country:US
Practice Address - Phone:208-345-2222
Practice Address - Fax:208-620-2215
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor