Provider Demographics
NPI:1184779266
Name:YOUNG, TIMOTHY JAMES JR (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:YOUNG
Suffix:JR
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 1:9020 CHERBOURG DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3105
Mailing Address - Country:US
Mailing Address - Phone:301-299-0085
Mailing Address - Fax:
Practice Address - Street 1:3206 TOWER OAKS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4254
Practice Address - Country:US
Practice Address - Phone:301-230-2001
Practice Address - Fax:301-230-2002
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01948111N00000X
VA0104555694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLR06YOOtherBLUE CROSS BLUE SHIELD
490608Medicare ID - Type Unspecified
MDLR06YOOtherBLUE CROSS BLUE SHIELD