Provider Demographics
NPI:1245699669
Name:SUYDAM, TAYLER (DC)
Entity type:Individual
Prefix:
First Name:TAYLER
Middle Name:
Last Name:SUYDAM
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 1:1149 SAND CREEK HWY
Mailing Address - Street 2:UNIT B
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1288
Mailing Address - Country:US
Mailing Address - Phone:517-577-6047
Mailing Address - Fax:517-577-6037
Practice Address - Street 1:1149 SAND CREEK HWY
Practice Address - Street 2:SUITE B
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1288
Practice Address - Country:US
Practice Address - Phone:517-577-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor