Healthcare Provider Details

I. General information

NPI: 1689911737
Provider Name (Legal Business Name): CHARLES W TAYLOR III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E MARKET ST
SCRANTON PA
18509-1257
US

IV. Provider business mailing address

703 E MARKET ST
SCRANTON PA
18509-1257
US

V. Phone/Fax

Practice location:
  • Phone: 570-507-9494
  • Fax:
Mailing address:
  • Phone: 570-507-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004981L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: