Provider Demographics
NPI:1194809137
Name:YOUNG, ANDREW MITCHELL (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MITCHELL
Last Name:YOUNG
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 1:2211 W STATE ST STE 122
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1951
Mailing Address - Country:US
Mailing Address - Phone:716-372-1236
Mailing Address - Fax:716-372-1915
Practice Address - Street 1:801 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2245
Practice Address - Country:US
Practice Address - Phone:716-372-1236
Practice Address - Fax:716-372-1915
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0007344368OtherACM
NY000588372005OtherBLUE CROSS BLUE SHIELD
NY0007344368OtherACM
NY000588372005OtherBLUE CROSS BLUE SHIELD