Provider Demographics
NPI:1437266517
Name:DR MICHAEL LEE TAYLOR A PROF CHIRO
Entity Type:Organization
Organization Name:DR MICHAEL LEE TAYLOR A PROF CHIRO
Other - Org Name:MICHAEL TAYLOR CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-521-1122
Mailing Address - Street 1:1421 STANDIFORD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0730
Mailing Address - Country:US
Mailing Address - Phone:209-521-1122
Mailing Address - Fax:209-521-4075
Practice Address - Street 1:1421 STANDIFORD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0730
Practice Address - Country:US
Practice Address - Phone:209-521-1122
Practice Address - Fax:209-521-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7345231Medicaid
U27413Medicare UPIN
CA121022Medicare ID - Type Unspecified