Provider Demographics
NPI:1528014297
Name:TAYLOR, THOMAS B III (DC CCEP)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:DC CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SE 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3907
Mailing Address - Country:US
Mailing Address - Phone:360-573-9669
Mailing Address - Fax:360-573-0448
Practice Address - Street 1:109 SE 101ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3907
Practice Address - Country:US
Practice Address - Phone:360-573-9669
Practice Address - Fax:360-573-0448
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3248111N00000X
IDCHIA1042111N00000X
OR3222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0113592OtherDEPT LABOR AND INDUSTRIES
112908OtherKAISER
1006336OtherAMERICAN SPECIALITY HLTH
070109OtherREGENCE BC
070109OtherREGENCE BC