Provider Demographics
NPI:1699019950
Name:ANDERSON, TAYLOR ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ROSS
Last Name:ANDERSON
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 1:508 S BOYD ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4953
Mailing Address - Country:US
Mailing Address - Phone:605-262-4059
Mailing Address - Fax:605-262-4060
Practice Address - Street 1:508 S BOYD ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4953
Practice Address - Country:US
Practice Address - Phone:605-262-4059
Practice Address - Fax:605-262-4060
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1699019950Medicaid