Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3067 | TX |
NPI | 1003933425 |
---|---|
Provider Name | Dr. Larry Joe Young |
First Address | Lubbock, TX 79412-1737 |
Second Address | Lubbock, TX 79412-1737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3067 | CHIROPRACTIC LICENSE (01) | TX |
U14137 | (02) |