Provider Demographics
NPI:1346993276
Name:ANDERSON, TAYLOR ALEXIS BLACKFORD (DC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXIS BLACKFORD
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ALEXIS
Other - Last Name:BLACKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3520 PAN AMERICAN FWY NE STE A1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4703
Mailing Address - Country:US
Mailing Address - Phone:505-308-8885
Mailing Address - Fax:
Practice Address - Street 1:3520 PAN AMERICAN FWY NE STE A1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4703
Practice Address - Country:US
Practice Address - Phone:505-308-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDC2281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor