Provider Demographics
NPI:1891109096
Name:YOUNG, JACOB (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
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 1:401 S GILBERT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4970
Mailing Address - Country:US
Mailing Address - Phone:319-337-6000
Mailing Address - Fax:
Practice Address - Street 1:401 S GILBERT ST
Practice Address - Street 2:STE 101
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4970
Practice Address - Country:US
Practice Address - Phone:319-337-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012612111N00000X
IA072778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor