Provider Demographics
NPI:1598969206
Name:YOUNG CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:YOUNG CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-521-4472
Mailing Address - Street 1:1912 BUNDY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2918
Mailing Address - Country:US
Mailing Address - Phone:765-521-4472
Mailing Address - Fax:765-521-4618
Practice Address - Street 1:1912 BUNDY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2918
Practice Address - Country:US
Practice Address - Phone:765-521-4472
Practice Address - Fax:765-521-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002132A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU99709Medicare UPIN