Provider Demographics
NPI:1740467679
Name:YOUNG, JASON JAMAAL (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMAAL
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 1:985 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4309
Mailing Address - Country:US
Mailing Address - Phone:541-753-1287
Mailing Address - Fax:541-752-1298
Practice Address - Street 1:985 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4309
Practice Address - Country:US
Practice Address - Phone:541-753-1287
Practice Address - Fax:541-752-1298
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor