Provider Demographics
NPI:1356539365
Name:TAYLOR, MICHAEL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 STANDIFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0730
Mailing Address - Country:US
Mailing Address - Phone:209-521-1122
Mailing Address - Fax:209-521-4075
Practice Address - Street 1:1421 STANDIFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0730
Practice Address - Country:US
Practice Address - Phone:209-521-1222
Practice Address - Fax:209-521-4075
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7345231Medicaid
CAU27413Medicare UPIN
CA121022Medicare PIN