Provider Demographics
NPI:1740392083
Name:YOUNG, THOMAS JAMES (DC, ND, PS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DC, ND, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 GRAVELLY LAKE DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3109
Mailing Address - Country:US
Mailing Address - Phone:253-584-1144
Mailing Address - Fax:253-588-5060
Practice Address - Street 1:8909 GRAVELLY LAKE DRIVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3109
Practice Address - Country:US
Practice Address - Phone:253-584-1144
Practice Address - Fax:253-588-5060
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 558175F00000X
WACH 2085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
G001001581Medicare ID - Type Unspecified
T 02855Medicare UPIN