Provider Demographics
NPI:1720091903
Name:YOUNG, DAVID THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
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 1:1179 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3733
Mailing Address - Country:US
Mailing Address - Phone:724-463-9510
Mailing Address - Fax:724-463-9511
Practice Address - Street 1:1179 S 6TH ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3733
Practice Address - Country:US
Practice Address - Phone:724-463-9510
Practice Address - Fax:724-463-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3979035OtherAETNA
PA649048OtherHCN ACN
PA3979035OtherAETNA
PAU94636Medicare UPIN