Harley Orville Youngblood, DCRN

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH00003002 Issued in WA

Practice address

11815 NE Highway 99
Ste. a
Vancouver, WA 98686-4008

Phone

(360) 696-4405

Fax

(360) 696-0582

NPI assigned

Aug 26, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beacon Chiropractic Co

  • Chiropractor
  • Vancouver, WA
  • NPI 1699199109
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347580800000",
    "number": "1346233103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11815 NE HIGHWAY 99",
            "address_2": "STE. A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986864008",
            "telephone_number": "360-696-4405",
            "fax_number": "360-696-0582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11815 NE HIGHWAY 99",
            "address_2": "STE. A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986864008",
            "telephone_number": "360-696-4405",
            "fax_number": "360-696-0582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "HARLEY",
        "middle_name": "ORVILLE",
        "name_prefix": "Mr.",
        "credential": "DCRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2012-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH00003002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "46659",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Niki L. Young
• Persis V Young, LMT
• Peter John Young
• Rona Young
• Stacy Young, RN
• Nicole Youngerman
• Youngman Vision Inc
• Trevor Shawn Youngquist, MA
• Kate Yturri, PA-C
• Yu and Kim DMD PLLC

• Chiropractor in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.