Provider Demographics
NPI:1891232153
Name:YOUNG CHIROPRACTIC & ACUPUNCTURE, LTD.
Entity Type:Organization
Organization Name:YOUNG CHIROPRACTIC & ACUPUNCTURE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KASSIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-359-0550
Mailing Address - Street 1:2911 CROSSING COURT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6108
Mailing Address - Country:US
Mailing Address - Phone:217-359-0550
Mailing Address - Fax:217-359-0808
Practice Address - Street 1:2911 CROSSING COURT
Practice Address - Street 2:SUITE 101
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6108
Practice Address - Country:US
Practice Address - Phone:217-359-0550
Practice Address - Fax:217-359-0808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG CHIROPRACTIC & ACUPUNCTURE, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-25
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012380111N00000X
038.012380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty