Provider Demographics
NPI:1881633535
Name:YOUNG, JEREMY
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 S MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1172
Mailing Address - Country:US
Mailing Address - Phone:765-521-4472
Mailing Address - Fax:765-521-4618
Practice Address - Street 1:3221 S MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1172
Practice Address - Country:US
Practice Address - Phone:765-521-4472
Practice Address - Fax:765-521-4618
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002132A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor