MEDICARE: JON KEVIN TAYLOR DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002244	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4881	OTHER	WA	LABOR & INDUSTRIES
2	8921637	OTHER	WA	CRIME VICTIM

General Provider Information

NPI Number	:	1154456424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON KEVIN TAYLOR DC

Provider Business Mailing Address
First Line	:	1822 BLACK LAKE BLVD SW STE 103
Second Line	:	NORTHWEST CHIROPRACTIC CENTER
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5628
Country	:	US
Telephone Number	:	360-943-0988
Fax Number	:	360-943-8021

Provider Business Practice Location Address
First Line	:	1822 BLACK LAKE BLVD SW STE 103
Second Line	:	NORTHWEST CHIROPRACTIC CENTER
City	:	OLYMPIA
State	:	WA
Zip	:	98512-5628
Country	:	US
Telephone Number	:	360-943-0988
Fax Number	:	360-943-8021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	12/13/2012

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Directions to “ JON KEVIN TAYLOR DC” Practice Location

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