Provider Demographics
NPI:1912192691
Name:YOUNG, CHAD RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RICHARD
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 1:964 121ST LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2139
Mailing Address - Country:US
Mailing Address - Phone:763-439-4634
Mailing Address - Fax:763-445-2121
Practice Address - Street 1:2785 WHITE BEAR AVE N STE 108
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1320
Practice Address - Country:US
Practice Address - Phone:651-415-0418
Practice Address - Fax:651-415-0106
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor