Provider Demographics
NPI:1538121280
Name:YOUNG, DANIEL L (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
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 1:2431 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3220
Mailing Address - Country:US
Mailing Address - Phone:814-838-9898
Mailing Address - Fax:814-838-8702
Practice Address - Street 1:2431 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3220
Practice Address - Country:US
Practice Address - Phone:814-838-9898
Practice Address - Fax:814-838-8702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003509L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU00456Medicare UPIN
PA168916Medicare ID - Type Unspecified