Healthcare Provider Details

I. General information

NPI: 1649467671
Provider Name (Legal Business Name): TAYLOR CHIROPRACTIC AND LASER CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SKYPARK DR
TORRANCE CA
90505-5316
US

IV. Provider business mailing address

4930 ELMDALE DR
ROLLING HILLS ESTATES CA
90274-2405
US

V. Phone/Fax

Practice location:
  • Phone: 310-891-0102
  • Fax: 310-891-0575
Mailing address:
  • Phone: 310-891-0102
  • Fax: 310-891-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC22871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30520
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8556
License Number StateCA

VIII. Authorized Official

Name: DR. DEREK M. TAYLOR
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 310-891-0102