Provider Demographics
NPI:1912115700
Name:TAYLOR, RICHARD SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAMUEL
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 1:525 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2108
Mailing Address - Country:US
Mailing Address - Phone:863-382-3700
Mailing Address - Fax:863-382-8564
Practice Address - Street 1:525 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2108
Practice Address - Country:US
Practice Address - Phone:863-382-3700
Practice Address - Fax:863-382-8564
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 3790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88745OtherBCBS INDIVIDUAL NUMBER
FL050404100Medicaid
FL350001351Medicare PIN
FL350001351Medicare UPIN
FL050404100Medicaid
FL88745OtherBCBS INDIVIDUAL NUMBER