Provider Demographics
NPI:1376681775
Name:TAYLOR, SHAWN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ROBERT
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-0370
Mailing Address - Country:US
Mailing Address - Phone:603-447-1131
Mailing Address - Fax:603-447-1145
Practice Address - Street 1:486 WHITE MOUNTAIN HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-4215
Practice Address - Country:US
Practice Address - Phone:603-447-1131
Practice Address - Fax:603-447-1145
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH689-0503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30252667Medicaid
NH657782OtherUNITEDHEALTHCARE
NH05Y005121NH02OtherANTHEM
NH8825681OtherCIGNA
NH657782OtherUNITEDHEALTHCARE
NH30252667Medicaid