Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 14232 | TX |
N | 111NN0400X | Neurology | 010036 | GA |
NPI | 1871088278 |
---|---|
Provider Name | Emily Catherine Youngblood |
First Address | Blanco, TX 78606-2028 |
Second Address | Blanco, TX 78606-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 16/10/2020 |