Provider Demographics
NPI:1407890544
Name:YOUNG, DANIEL EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:EDWARD
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:612 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1338
Mailing Address - Country:US
Mailing Address - Phone:215-257-5757
Mailing Address - Fax:215-257-1752
Practice Address - Street 1:612 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1338
Practice Address - Country:US
Practice Address - Phone:215-257-5757
Practice Address - Fax:215-257-1752
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003876L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA546312Medicare UPIN
PA546312Medicare ID - Type Unspecified