Provider Demographics
NPI:1568509453
Name:DR. JULIE J. TRAYLOR, LLC
Entity Type:Organization
Organization Name:DR. JULIE J. TRAYLOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:JENE
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-739-4242
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5GA61Medicare PIN