Provider Demographics
NPI:1386121200
Name:FOREVER YOUNG CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:FOREVER YOUNG CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-444-3220
Mailing Address - Street 1:4305 WINDSOR CENTRE TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:469-444-3220
Mailing Address - Fax:469-444-3222
Practice Address - Street 1:4305 WINDSOR CENTRE TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:469-444-3220
Practice Address - Fax:469-444-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13385111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty