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General NPI Number Information
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NPI Number | 1740913391
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Entity Type | Individual
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Provider Name | DAKOTA YOUNG ATC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 361 W MAIN ST
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City | ALBION
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State | IL
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Zip | 62806-1071
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Country | US
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Telephone | 618-599-1339
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 COLLEGE DRIVE
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City | MT. CARMEL
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State | IL
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Zip | 62863
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096004937
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License Number State | IL
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