MEDICARE: TAYLOR J CANFIELD A.T.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	405300000X	Prevention Professional	2000023027	MT

General Provider Information

NPI Number	:	1346771797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR J CANFIELD A.T.C.

Provider Business Mailing Address
First Line	:	1602 WICKS LN UNIT 3
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-6404
Country	:	US
Telephone Number	:	972-800-5823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 WICKS LN UNIT 3
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-6404
Country	:	US
Telephone Number	:	972-800-5823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/27/2017

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