Provider Demographics
NPI:1780717876
Name:YOUNG, JOHN PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN PAUL
Middle Name:
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 1:502 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7247
Mailing Address - Country:US
Mailing Address - Phone:203-932-5620
Mailing Address - Fax:
Practice Address - Street 1:214 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3206
Practice Address - Country:US
Practice Address - Phone:203-777-2225
Practice Address - Fax:203-776-4266
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor