Healthcare Provider Details

I. General information

NPI: 1114646023
Provider Name (Legal Business Name): KYLE ANDREW TAYLOR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 W LOWER BUCKEYE RD
PHOENIX AZ
85043-3439
US

IV. Provider business mailing address

7710 W LOWER BUCKEYE RD
PHOENIX AZ
85043-3439
US

V. Phone/Fax

Practice location:
  • Phone: 623-776-2225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01921
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: