Provider Demographics
NPI:1316267552
Name:YOUNG, GARY (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
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 1:1308 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-1612
Mailing Address - Country:US
Mailing Address - Phone:610-532-0657
Mailing Address - Fax:610-870-0325
Practice Address - Street 1:1308 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-1612
Practice Address - Country:US
Practice Address - Phone:610-532-0657
Practice Address - Fax:610-870-0325
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9952111N00000X
PADC010443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor