Provider Demographics
NPI:1972531390
Name:TAYLOR, TOMMY DWAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:DWAYNE
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 1:307 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1361
Mailing Address - Country:US
Mailing Address - Phone:606-638-9898
Mailing Address - Fax:606-638-0748
Practice Address - Street 1:307 W MADISON ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1361
Practice Address - Country:US
Practice Address - Phone:606-638-9898
Practice Address - Fax:606-638-0748
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0510000000Medicaid
000000042934OtherBLUE CROSS BLUE SHIELD
KY85000099Medicaid
5821703OtherAETNA
U82353Medicare UPIN
5821703OtherAETNA