=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003958331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHAD STEVEN YOUNG D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 10/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 PARIS RD STE 341
-----------------------------------------------------
City | MAYFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42066-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-251-0907
-----------------------------------------------------
Fax | 270-251-0908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 PARIS RD STE 341
-----------------------------------------------------
City | MAYFIELD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42066-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-251-0907
-----------------------------------------------------
Fax | 270-251-0908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4764
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2623
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------