=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184254062
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTY TAYLOR L.AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2020
-----------------------------------------------------
Last Update Date | 11/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4783 SW HIGHWAY 101
-----------------------------------------------------
City | LINCOLN CITY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97367-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-652-0280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4783 SW HIGHWAY 101
-----------------------------------------------------
City | LINCOLN CITY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97367-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-652-0280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 1291
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC216578
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------