Provider Demographics
NPI:1013361534
Name:YOUNG, MICHAEL L (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
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 1:4106 FLINTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1534
Mailing Address - Country:US
Mailing Address - Phone:859-652-5689
Mailing Address - Fax:502-688-6468
Practice Address - Street 1:4106 FLINTLOCK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1534
Practice Address - Country:US
Practice Address - Phone:859-652-5689
Practice Address - Fax:502-688-6468
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY249133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100405870Medicaid
KYK144101Medicare PIN
KY7100405870Medicaid