Provider Demographics
NPI:1477425510
Name:GODNICK, TAYLOR RAE (DC)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:RAE
Last Name:GODNICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31093 TEMECULA PKWY UNIT D3
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3087
Mailing Address - Country:US
Mailing Address - Phone:951-470-2645
Mailing Address - Fax:
Practice Address - Street 1:31093 TEMECULA PKWY UNIT D3
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3087
Practice Address - Country:US
Practice Address - Phone:951-470-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC35217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor