Provider Demographics
NPI:1932412988
Name:E.T.D.C., LLC.
Entity Type:Organization
Organization Name:E.T.D.C., LLC.
Other - Org Name:CHIROPRACTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-517-4122
Mailing Address - Street 1:1201 NW 178TH ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4279
Mailing Address - Country:US
Mailing Address - Phone:214-517-4122
Mailing Address - Fax:
Practice Address - Street 1:1201 NW 178TH ST
Practice Address - Street 2:SUITE 119
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4279
Practice Address - Country:US
Practice Address - Phone:214-517-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty