Provider Demographics
NPI:1811408685
Name:YOUNG CHIROPRACTIC AND REHAB, LLC
Entity Type:Organization
Organization Name:YOUNG CHIROPRACTIC AND REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-246-0025
Mailing Address - Street 1:10400 EATON PL STE 410
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2208
Mailing Address - Country:US
Mailing Address - Phone:703-246-0025
Mailing Address - Fax:703-246-0017
Practice Address - Street 1:10400 EATON PL STE 410
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2208
Practice Address - Country:US
Practice Address - Phone:703-246-0025
Practice Address - Fax:703-246-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043614308OtherNPI