Provider Demographics
NPI:1578869152
Name:YOUNG FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:YOUNG FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-602-0893
Mailing Address - Street 1:450 PORT ORCHARD BLVD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4705
Mailing Address - Country:US
Mailing Address - Phone:360-602-0893
Mailing Address - Fax:360-602-0895
Practice Address - Street 1:450 PORT ORCHARD BLVD
Practice Address - Street 2:SUITE 390
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4705
Practice Address - Country:US
Practice Address - Phone:360-602-0893
Practice Address - Fax:360-602-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60167543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty