Provider Demographics
NPI:1750497731
Name:YOUNG FAMILY CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:YOUNG FAMILY CHIROPRACTIC CLINIC, P.C.
Other - Org Name:BELLFORT CHIROPRACTIC CENTER / LES MICHAEL YOUNG, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-643-5454
Mailing Address - Street 1:7644 BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1704
Mailing Address - Country:US
Mailing Address - Phone:713-643-5454
Mailing Address - Fax:713-643-5456
Practice Address - Street 1:7644 BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1704
Practice Address - Country:US
Practice Address - Phone:713-643-5454
Practice Address - Fax:713-643-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5336111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0884926-02Medicaid
TX0884926-02Medicaid
TXTXB121201Medicare PIN