Provider Demographics
NPI:1740513829
Name:DONOVAN, TAYLOR (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:DONOVAN
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 1:1055 W MOANA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4776
Mailing Address - Country:US
Mailing Address - Phone:775-852-0446
Mailing Address - Fax:
Practice Address - Street 1:1055 W MOANA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4776
Practice Address - Country:US
Practice Address - Phone:775-852-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB1200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor