Provider Demographics
NPI:1730664681
Name:YOUNG, JILL DARLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:DARLEEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:DARLEEN
Other - Last Name:ENEBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2155 E US HIGHWAY 377
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5951
Mailing Address - Country:US
Mailing Address - Phone:682-233-0160
Mailing Address - Fax:
Practice Address - Street 1:2155 E US HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-5951
Practice Address - Country:US
Practice Address - Phone:682-233-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor