Provider Demographics
NPI:1497112536
Name:FUNKE, TAYLOR (DC, MS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FUNKE
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-3321
Mailing Address - Country:US
Mailing Address - Phone:515-225-2237
Mailing Address - Fax:515-379-7068
Practice Address - Street 1:761 W 210TH DR
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-1781
Practice Address - Country:US
Practice Address - Phone:785-346-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor