Provider Demographics
NPI:1760518229
Name:YOUNG CHIROPRACTIC INC
Entity Type:Organization
Organization Name:YOUNG CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THRESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-492-2129
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44854
Mailing Address - Country:US
Mailing Address - Phone:419-492-2129
Mailing Address - Fax:419-492-3344
Practice Address - Street 1:201S KIBLER ST
Practice Address - Street 2:
Practice Address - City:NEW WASHINGTON
Practice Address - State:OH
Practice Address - Zip Code:44854
Practice Address - Country:US
Practice Address - Phone:419-492-2129
Practice Address - Fax:419-492-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0867736Medicaid
282726456002OtherMEDICAL MUTUAL OF OHIO
000000131591OtherANTHEM BC & BS
282726456002OtherMEDICAL MUTUAL OF OHIO
=========Medicare UPIN