Provider Demographics
NPI:1609211200
Name:LEVICK, TAYLOR JOURDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JOURDAN
Last Name:LEVICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ACKLINS CIR
Mailing Address - Street 2:APARTMENT 308
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-9781
Mailing Address - Country:US
Mailing Address - Phone:813-230-3607
Mailing Address - Fax:
Practice Address - Street 1:949 BEVILLE RD
Practice Address - Street 2:D-5
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1705
Practice Address - Country:US
Practice Address - Phone:813-230-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor