Provider Demographics
NPI:1760519045
Name:YOUNG, JEFFREY A (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17425 STUEBNER AIRLINE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3708
Mailing Address - Country:US
Mailing Address - Phone:281-370-4491
Mailing Address - Fax:281-370-4492
Practice Address - Street 1:17425 STUEBNER AIRLINE RD STE C
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3708
Practice Address - Country:US
Practice Address - Phone:281-370-4491
Practice Address - Fax:281-370-4492
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5725DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX604497OtherBLUE CROSS
TX604497OtherBLUE CROSS
TX604497Medicare ID - Type Unspecified