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General NPI Number Information
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NPI Number | 1336947019
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Entity Type | Individual
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Provider Name | TAYLOR ANN MIRACLE DC
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Gender | Female
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 30 ACOMA BLVD S
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5957
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Country | US
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Telephone | 928-680-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 BLUEWATER DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5311
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Country | US
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Telephone | 661-547-0642
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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 | 9427
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License Number State | AZ
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