Provider Demographics
NPI:1154456424
Name:TAYLOR, JON KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:KEVIN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 BLACK LAKE BLVD SW STE 103
Mailing Address - Street 2:NORTHWEST CHIROPRACTIC CENTER
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5628
Mailing Address - Country:US
Mailing Address - Phone:360-943-0988
Mailing Address - Fax:360-943-8021
Practice Address - Street 1:1822 BLACK LAKE BLVD SW STE 103
Practice Address - Street 2:NORTHWEST CHIROPRACTIC CENTER
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5628
Practice Address - Country:US
Practice Address - Phone:360-943-0988
Practice Address - Fax:360-943-8021
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4881OtherLABOR & INDUSTRIES
WA8921637OtherCRIME VICTIM
601129704Medicare UPIN
001002300Medicare ID - Type Unspecified