Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2623 | TN |
Y | 111N00000X | Chiropractor | 4764 | KY |
NPI | 1003958331 |
---|---|
Provider Name | Dr. Chad Steven Young |
First Address | Mayfield, KY 42066-3306 |
Second Address | Mayfield, KY 42066-3306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 16/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000289323 | ANTHEM PIN (01) | KY |
85002699 | (05) | KY |
U94267 | (02) | KY |