Provider Demographics
NPI:1306994066
Name:YOUNG, GREGORY DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DOUGLAS
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 1:200 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-7115
Mailing Address - Country:US
Mailing Address - Phone:432-524-5580
Mailing Address - Fax:432-524-5583
Practice Address - Street 1:200 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-7115
Practice Address - Country:US
Practice Address - Phone:432-524-5580
Practice Address - Fax:432-524-5583
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146738301Medicaid
TX607054OtherBCBS
TX609573Medicare ID - Type Unspecified
TXU69709Medicare UPIN