Provider Demographics
NPI:1164447827
Name:TAYLOR, TYLER THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:THOMAS
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 1:445 ROSEWOOD AVE
Mailing Address - Street 2:SUITE #A
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5929
Mailing Address - Country:US
Mailing Address - Phone:805-484-8930
Mailing Address - Fax:805-987-5323
Practice Address - Street 1:445 ROSEWOOD AVE
Practice Address - Street 2:SUITE #A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5929
Practice Address - Country:US
Practice Address - Phone:805-484-8930
Practice Address - Fax:805-987-5323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29731Medicare ID - Type Unspecified