Provider Demographics
NPI:1881886893
Name:TAYLOR, J. DUSTIN (DC)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:DUSTIN
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 1:1361 WHITE DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9467
Mailing Address - Country:US
Mailing Address - Phone:870-698-1650
Mailing Address - Fax:
Practice Address - Street 1:1361 WHITE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9467
Practice Address - Country:US
Practice Address - Phone:870-698-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR393489ZML8Medicare PIN