Provider Demographics
NPI:1427195411
Name:TRAYLOR, JULIE JENE (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:JENE
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2482 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9015
Mailing Address - Country:US
Mailing Address - Phone:870-739-4242
Mailing Address - Fax:870-739-6881
Practice Address - Street 1:2482 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9015
Practice Address - Country:US
Practice Address - Phone:870-739-4242
Practice Address - Fax:870-739-6881
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T822Medicare ID - Type Unspecified