MEDICARE: NANCY LEE 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	CE005548	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	431576505	OTHER	MO	FEDERAL TAX NUMBER
2	14340	OTHER	MO	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1902876865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LEE YOUNG D.C.

Provider Business Mailing Address
First Line	:	3442 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2055
Country	:	US
Telephone Number	:	314-781-7336
Fax Number	:	314-781-4241

Provider Business Practice Location Address
First Line	:	3442 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2055
Country	:	US
Telephone Number	:	314-781-7336
Fax Number	:	314-781-4241

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/14/2010

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