Provider Demographics
NPI:1700202512
Name:YOUNG, JARED (DC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
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 1:8780 WARNER AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3210
Mailing Address - Country:US
Mailing Address - Phone:714-591-3601
Mailing Address - Fax:
Practice Address - Street 1:8780 WARNER AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3210
Practice Address - Country:US
Practice Address - Phone:714-591-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor