Provider Demographics
NPI:1710954565
Name:YOUNG, JEANNE M (DC PC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW WALL ST
Mailing Address - Street 2:100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2731
Mailing Address - Country:US
Mailing Address - Phone:541-389-5232
Mailing Address - Fax:541-389-5232
Practice Address - Street 1:777 NW WALL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2731
Practice Address - Country:US
Practice Address - Phone:541-389-5232
Practice Address - Fax:541-389-5232
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272670111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130765Medicare ID - Type Unspecified
OR130761Medicare ID - Type Unspecified