Provider Demographics
NPI:1053426627
Name:TAYLOR, RICHARD WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WAYNE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 COFFEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3181
Mailing Address - Country:US
Mailing Address - Phone:209-575-9577
Mailing Address - Fax:209-575-9576
Practice Address - Street 1:1508 COFFEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3181
Practice Address - Country:US
Practice Address - Phone:209-575-9577
Practice Address - Fax:209-575-9576
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0211410Medicare ID - Type Unspecified