MEDICARE: DR. JEFFREY WILLIAM DEYOUNG 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	21938	CA
2	111N00000X	Chiropractor	CHIR007758	GA
3	111N00000X	Chiropractor	13862	TX

General Provider Information

NPI Number	:	1871500074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY WILLIAM DEYOUNG D.C.

Provider Business Mailing Address
First Line	:	8106 BRODIE LN STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-7468
Country	:	US
Telephone Number	:	512-442-7999
Fax Number	:	512-442-8244

Provider Business Practice Location Address
First Line	:	8106 BRODIE LN STE 107
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745
Country	:	US
Telephone Number	:	512-442-7999
Fax Number	:	512-442-8244

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/23/2018

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