Provider Demographics
NPI:1861547135
Name:YOUNG, JEANETTE A (DC)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 67TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-5004
Mailing Address - Country:US
Mailing Address - Phone:806-791-5262
Mailing Address - Fax:806-791-5262
Practice Address - Street 1:4706 67TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-5004
Practice Address - Country:US
Practice Address - Phone:806-791-5262
Practice Address - Fax:806-791-5262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor