Provider Demographics
NPI:1063472223
Name:YOUNGINER, ERIK (DC)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:YOUNGINER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 OTT STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:612 OTT STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1846
Practice Address - Country:US
Practice Address - Phone:803-799-7101
Practice Address - Fax:803-799-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH 2602Medicaid
SCU889937299Medicare ID - Type Unspecified
SC7299Medicare PIN