Healthcare Provider Details

I. General information

NPI: 1861604886
Provider Name (Legal Business Name): THOMAS DEAN TAYLOR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 WHITE DRIVE
BATESVILLE AR
72501
US

IV. Provider business mailing address

P.O. BOX 2544
BATESVILLE AR
72503-2544
US

V. Phone/Fax

Practice location:
  • Phone: 870-698-1650
  • Fax: 870-793-4790
Mailing address:
  • Phone: 870-698-1650
  • Fax: 870-793-4790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number940
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: