Provider Demographics
NPI:1205437977
Name:HAAK, TAYLOR DENTON LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:DENTON LEWIS
Last Name:HAAK
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 1:16903 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6307 NE 117TH AVE STE C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5500
Practice Address - Country:US
Practice Address - Phone:360-253-4285
Practice Address - Fax:360-253-9469
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61062221111N00000X
COCHR.0008181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCHR.0008181OtherSTATE OF COLORADO
WACH61062221OtherSTATE OF WASHINGTON