Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | C01643 | MD |
NPI | 1154552644 |
---|---|
Provider Name | Leon Young |
First Address | Dundalk, MD 21222-0284 |
Second Address | Baltimore, MD 21218-3122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2009 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
695Q | (02) | MD |