Healthcare Provider Details

I. General information

NPI: 1760657977
Provider Name (Legal Business Name): JEANNE YOUNG DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888NW HILL STREET 6
BEND OR
97701
US

IV. Provider business mailing address

777 NW WALL ST 100
BEND OR
97701-2731
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-5213
  • Fax: 541-389-5232
Mailing address:
  • Phone: 541-389-5232
  • Fax: 541-389-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number272670
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. JEANNE M YOUNG
Title or Position: PRESIDENT
Credential: DC
Phone: 541-389-5232