Provider Demographics
NPI:1194975532
Name:YOUNG, SARA (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
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 1:510 W SAVIDGE ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-3108
Mailing Address - Country:US
Mailing Address - Phone:616-850-0588
Mailing Address - Fax:
Practice Address - Street 1:510 W SAVIDGE ST STE E
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-3108
Practice Address - Country:US
Practice Address - Phone:616-850-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP38500007Medicare PIN