Provider Demographics
NPI:1821494063
Name:CLIFFORD, TAYLOR (DC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-1311
Mailing Address - Country:US
Mailing Address - Phone:574-946-4113
Mailing Address - Fax:574-846-4552
Practice Address - Street 1:12 ELSTON RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-7000
Practice Address - Country:US
Practice Address - Phone:765-477-7707
Practice Address - Fax:765-477-7770
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002810A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor