MEDICARE: DR. RICHARD GRANT YOUNG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4312	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4312	OTHER	TX	LICENSE NUMBER

General Provider Information

NPI Number	:	1235297011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GRANT YOUNG D.C.

Provider Business Mailing Address
First Line	:	2813 ALTA MERE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4112
Country	:	US
Telephone Number	:	817-735-1121
Fax Number	:	817-735-1163

Provider Business Practice Location Address
First Line	:	2813 ALTA MERE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-4112
Country	:	US
Telephone Number	:	817-735-1121
Fax Number	:	817-735-1163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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