Healthcare Provider Details

I. General information

NPI: 1154552644
Provider Name (Legal Business Name): LEON YOUNG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 HARFORD RD
BALTIMORE MD
21218-3122
US

IV. Provider business mailing address

PO BOX 9284
DUNDALK MD
21222-0284
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-9227
  • Fax:
Mailing address:
  • Phone: 410-350-6064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberC01643
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: