Provider Demographics
NPI:1952785875
Name:YOUNG, ARIEL ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:ELIZABETH
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 1:810 S CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1804
Mailing Address - Country:US
Mailing Address - Phone:309-944-1213
Mailing Address - Fax:309-944-1213
Practice Address - Street 1:810 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1804
Practice Address - Country:US
Practice Address - Phone:309-944-1213
Practice Address - Fax:309-944-1213
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF900230200Medicare PIN