Provider Demographics
NPI:1871500074
Name:DEYOUNG, JEFFREY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:DEYOUNG
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 1:8106 BRODIE LN STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7468
Mailing Address - Country:US
Mailing Address - Phone:512-442-7999
Mailing Address - Fax:512-442-8244
Practice Address - Street 1:8106 BRODIE LN STE 107
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-442-7999
Practice Address - Fax:512-442-8244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21938111N00000X
GACHIR007758111N00000X
TX13862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJFCMedicare PIN
GAU38715Medicare UPIN