Provider Demographics
NPI:1457782856
Name:TAYLOR, TRAVIS RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:RYAN
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 1:20772 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1146
Mailing Address - Country:US
Mailing Address - Phone:305-932-3773
Mailing Address - Fax:305-932-4410
Practice Address - Street 1:20772 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1146
Practice Address - Country:US
Practice Address - Phone:305-932-3773
Practice Address - Fax:305-932-4410
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4418111N00000X
FLCH11151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor