Provider Demographics
NPI:1659618692
Name:TAYLOR, TRAVIS RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:RYAN
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 1:2327 S DIRKSEN PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4508
Mailing Address - Country:US
Mailing Address - Phone:217-638-2031
Mailing Address - Fax:217-544-3627
Practice Address - Street 1:2327 S DIRKSEN PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4508
Practice Address - Country:US
Practice Address - Phone:217-544-3628
Practice Address - Fax:217-544-3627
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-012343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor