Healthcare Provider Details

I. General information

NPI: 1629297544
Provider Name (Legal Business Name): MICHAEL KIM TAYLOR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 E 51ST ST
TULSA OK
74135-3657
US

IV. Provider business mailing address

3808 E 51ST ST
TULSA OK
74135-3657
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-3797
  • Fax: 918-749-1536
Mailing address:
  • Phone: 918-749-3797
  • Fax: 918-749-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number2087
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: