Provider Demographics
NPI:1518034099
Name:YOUNG, JAY EVERETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:EVERETTE
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 1:102 WEST CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9760
Mailing Address - Country:US
Mailing Address - Phone:864-855-2422
Mailing Address - Fax:864-855-1908
Practice Address - Street 1:4628 CALHOUN MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3829
Practice Address - Country:US
Practice Address - Phone:864-855-2422
Practice Address - Fax:864-855-1908
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU235458177Medicare PIN