Provider Demographics
NPI:1932138641
Name:TALIAFERRO, THOMAS LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:TALIAFERRO
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 1:978 N NORMA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3150
Mailing Address - Country:US
Mailing Address - Phone:760-446-1088
Mailing Address - Fax:
Practice Address - Street 1:978 N NORMA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3150
Practice Address - Country:US
Practice Address - Phone:760-446-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25520111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932138641OtherNPI
CADC0255202OtherBLUE SHIELD
CA1932138641OtherNPI
CADC0255202OtherBLUE SHIELD