Provider Demographics
NPI:1871088278
Name:YOUNGBLOOD, EMILY CATHERINE (DC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 TEJAS TRL
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-2028
Mailing Address - Country:US
Mailing Address - Phone:770-294-3267
Mailing Address - Fax:
Practice Address - Street 1:1450 TEJAS TRL
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-2028
Practice Address - Country:US
Practice Address - Phone:770-294-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010036111NN0400X
TX14232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology