Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH60908669 | WA |
N | 111NP0017X | Pediatric Chiropractor | CH60908669 | WA |
NPI | 1669799755 |
---|---|
Provider Name | Dr. Jessie Lyn Young |
First Address | Spokane, WA 99201-0302 |
Second Address | Olympia, WA 98512-5651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 12/02/2021 |