Provider Demographics
NPI:1770799827
Name:YOUNG, STACY CHARLENE (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:CHARLENE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11421 OLD GLENN HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7729
Mailing Address - Country:US
Mailing Address - Phone:907-694-2273
Mailing Address - Fax:
Practice Address - Street 1:11421 OLD GLENN HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7729
Practice Address - Country:US
Practice Address - Phone:907-694-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor