1033149620 NPI number — DR. ALYSSA-RAE Z YOUNGER D.C.

Table of content: DR. ALYSSA-RAE Z YOUNGER D.C. (NPI 1033149620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033149620 NPI number — DR. ALYSSA-RAE Z YOUNGER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNGER
Provider First Name:
ALYSSA-RAE
Provider Middle Name:
Z
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZONARICH
Provider Other First Name:
ALYSSA-RAE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033149620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1016 S LINDENWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66062-2334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-908-1291
Provider Business Mailing Address Fax Number:
913-402-7450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11960 QUIVIRA RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-402-7444
Provider Business Practice Location Address Fax Number:
913-402-7450
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104968 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S67D789 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 9408533 . This is a "PHCS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 35510011 . This is a "BC/BS PROVIDER NO." identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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