Provider Demographics
NPI:1265408876
Name:YOUNG, BRYAN E
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5005
Mailing Address - Country:US
Mailing Address - Phone:918-687-5551
Mailing Address - Fax:918-686-7104
Practice Address - Street 1:2602 CHANDLER RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5005
Practice Address - Country:US
Practice Address - Phone:918-687-5551
Practice Address - Fax:918-686-7104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T292888Medicare UPIN