Provider Demographics
NPI:1710045232
Name:YOUNG, TIMOTHY EARL (DC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EARL
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 1:6020 N ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7426
Mailing Address - Country:US
Mailing Address - Phone:405-767-9750
Mailing Address - Fax:405-767-9759
Practice Address - Street 1:6020 N ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7426
Practice Address - Country:US
Practice Address - Phone:405-767-9750
Practice Address - Fax:405-767-9759
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522069OtherGROUP PROVIDER NUMBER
OKU61592Medicare UPIN
OK242413501Medicare ID - Type Unspecified