Provider Demographics
NPI:1689698706
Name:YOUNG, LAURA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 RACE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1636
Mailing Address - Country:US
Mailing Address - Phone:330-602-7778
Mailing Address - Fax:
Practice Address - Street 1:922 RACE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1636
Practice Address - Country:US
Practice Address - Phone:330-602-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH300297216-00OtherOHIO BWC ID #
OHYO0897503Medicare ID - Type UnspecifiedMEDICARE ID NUMBER