Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC22401 | CA |
NPI | 1043218746 |
---|---|
Provider Name | Mr. Carol Lynne Young |
First Address | Huntington Beach, CA 92649-4660 |
Second Address | Huntington Beach, CA 92649-4660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 08/07/2007 |