Provider Demographics
NPI:1609200948
Name:TALIAFERRO CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:TALIAFERRO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:TALIAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-446-1088
Mailing Address - Street 1:978 N NORMA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3150
Mailing Address - Country:US
Mailing Address - Phone:760-446-1088
Mailing Address - Fax:
Practice Address - Street 1:978 N NORMA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3150
Practice Address - Country:US
Practice Address - Phone:760-446-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0255202Medicare UPIN