Provider Demographics
NPI:1730519463
Name:DESERT VALLEY CHIROPRACTIC
Entity type:Organization
Organization Name:DESERT VALLEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-727-8900
Mailing Address - Street 1:2250 POSTAL
Mailing Address - Street 2:#4
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4798
Mailing Address - Country:US
Mailing Address - Phone:775-727-8900
Mailing Address - Fax:775-727-9452
Practice Address - Street 1:2250 POSTAL
Practice Address - Street 2:#4
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4798
Practice Address - Country:US
Practice Address - Phone:775-727-8900
Practice Address - Fax:775-727-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFK525AMedicare PIN
NV1417148354Medicare NSC
NVU57529Medicare UPIN