Provider Demographics
NPI:1629297544
Name:TAYLOR, MICHAEL KIM (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KIM
Last Name:TAYLOR
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 1:3808 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3657
Mailing Address - Country:US
Mailing Address - Phone:918-749-3797
Mailing Address - Fax:918-749-1536
Practice Address - Street 1:3808 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3657
Practice Address - Country:US
Practice Address - Phone:918-749-3797
Practice Address - Fax:918-749-1536
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2087111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT80030Medicare UPIN