Healthcare Provider Details

I. General information

NPI: 1023061371
Provider Name (Legal Business Name): TIMOTHY YOUNG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30838 SCHOENHERR RD
WARREN MI
48088-6856
US

IV. Provider business mailing address

24295 WARRINGTON CT
EASTPOINTE MI
48021-1323
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-4000
  • Fax:
Mailing address:
  • Phone: 586-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: