Provider Demographics
NPI:1225071525
Name:TAYLOR, LAWRENCE ROBERT III (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:TAYLOR
Suffix:III
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 1:621 KLAMATH AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6130
Mailing Address - Country:US
Mailing Address - Phone:541-882-5602
Mailing Address - Fax:541-882-5897
Practice Address - Street 1:621 KLAMATH AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6130
Practice Address - Country:US
Practice Address - Phone:541-882-5602
Practice Address - Fax:541-882-5897
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR116692Medicare PIN