Provider Demographics
NPI:1740307180
Name:YOUNG C & A
Entity type:Organization
Organization Name:YOUNG C & A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-763-8361
Mailing Address - Street 1:4201 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-1737
Mailing Address - Country:US
Mailing Address - Phone:806-763-8361
Mailing Address - Fax:806-762-6383
Practice Address - Street 1:4201 AVENUE R
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-1737
Practice Address - Country:US
Practice Address - Phone:806-763-8361
Practice Address - Fax:806-762-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3067OtherCHIROPRACTIC LICENSE
601301Medicare ID - Type Unspecified
TX3067OtherCHIROPRACTIC LICENSE