Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1716 | OH |
NPI | 1003037987 |
---|---|
Provider Name | Dr. Thresa M Young |
First Address | New Washington, OH 44854 |
Second Address | New Washington, OH 44854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 29/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000131591 | ANTHEM (01) | |
0867736 | (05) | OH |
341410537 | (02) |