Provider Demographics
NPI:1497972756
Name:YOUNG, DAVID S (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
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 1:12795 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2704
Mailing Address - Country:US
Mailing Address - Phone:503-646-3511
Mailing Address - Fax:
Practice Address - Street 1:12795 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2704
Practice Address - Country:US
Practice Address - Phone:503-646-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 1529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQGCBFMedicare ID - Type UnspecifiedMEDICARE ID