Provider Demographics
NPI:1861604886
Name:TAYLOR, THOMAS DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DEAN
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:P.O. BOX 2544
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2544
Mailing Address - Country:US
Mailing Address - Phone:870-698-1650
Mailing Address - Fax:870-793-4790
Practice Address - Street 1:1361 WHITE DRIVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501
Practice Address - Country:US
Practice Address - Phone:870-698-1650
Practice Address - Fax:870-793-4790
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102737718Medicaid
AR59896Medicare PIN