MEDICARE: MR. TIMOTHY EARL YOUNG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3256	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200522069	OTHER	OK	GROUP PROVIDER NUMBER

General Provider Information

NPI Number	:	1710045232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY EARL YOUNG D.C.

Provider Business Mailing Address
First Line	:	6020 N ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7426
Country	:	US
Telephone Number	:	405-767-9750
Fax Number	:	405-767-9759

Provider Business Practice Location Address
First Line	:	6020 N ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7426
Country	:	US
Telephone Number	:	405-767-9750
Fax Number	:	405-767-9759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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