Healthcare Provider Details

I. General information

NPI: 1699770743
Provider Name (Legal Business Name): SIDNEY D. TAYLOR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 N MERIDIAN AVE STE 101
OKLAHOMA CITY OK
73112-2813
US

IV. Provider business mailing address

3617 N MERIDIAN AVE SUITE 101
OKLAHOMA CITY OK
73112-2824
US

V. Phone/Fax

Practice location:
  • Phone: 405-946-9946
  • Fax: 405-946-0757
Mailing address:
  • Phone: 405-946-9946
  • Fax: 405-946-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3287
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6787
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: