MEDICARE: DR. TONYA YOUNGBLOOD DC

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	12735	TX

General Provider Information

NPI Number	:	1447650916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONYA YOUNGBLOOD DC

Provider Business Mailing Address
First Line	:	1201 N WATSON RD STE 145
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6223
Country	:	US
Telephone Number	:	682-270-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N WATSON RD STE 145
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6223
Country	:	US
Telephone Number	:	682-270-0002
Fax Number	:

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	11/29/2022

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