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General NPI Number Information
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NPI Number | 1205437977
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Entity Type | Individual
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Provider Name | TAYLOR DENTON LEWIS HAAK DC
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Gender | Male
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Dates
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Enumeration Date | 11/07/2020
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 6307 NE 117TH AVE STE C
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City | VANCOUVER
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State | WA
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Zip | 98662-5500
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Country | US
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Telephone | 360-253-4285
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Fax | 360-253-9469
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Provider Business Mailing Address
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Address Line | 16903 NE 20TH ST
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City | VANCOUVER
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State | WA
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Zip | 98684-6766
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH61062221
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR.0008181
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License Number State | CO
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