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General NPI Number Information
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NPI Number | 1609211200
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Entity Type | Individual
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Provider Name | TAYLOR JOURDAN LEVICK D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 170 S PANTOPS DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8672
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Country | US
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Telephone | 434-260-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 AVEMORE POND RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-7235
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Country | US
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Telephone | 434-260-4422
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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 | 0104-557745
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License Number State | VA
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