Provider Demographics
NPI:1174374920
Name:YOUNG, ZACHARY TYLER (LAC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:TYLER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 CIRCLE POINT RD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2889
Mailing Address - Country:US
Mailing Address - Phone:269-908-3814
Mailing Address - Fax:
Practice Address - Street 1:3314 MESA RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1036
Practice Address - Country:US
Practice Address - Phone:719-428-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002768171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist