Provider Demographics
NPI:1154897866
Name:DEYOUNG CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DEYOUNG CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-442-7999
Mailing Address - Street 1:8106 BRODIE LN STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7468
Mailing Address - Country:US
Mailing Address - Phone:512-442-7999
Mailing Address - Fax:512-442-8244
Practice Address - Street 1:8106 BRODIE LN STE 107
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7468
Practice Address - Country:US
Practice Address - Phone:512-442-7999
Practice Address - Fax:512-442-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service