Provider Demographics
NPI:1457608507
Name:FOREVER YOUNG HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:FOREVER YOUNG HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-544-1401
Mailing Address - Street 1:542 W 2400 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4727
Mailing Address - Country:US
Mailing Address - Phone:801-544-1401
Mailing Address - Fax:801-544-1404
Practice Address - Street 1:1410 N HILL FIELD RD STE 4
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5056
Practice Address - Country:US
Practice Address - Phone:801-544-1401
Practice Address - Fax:801-544-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4999756-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty