MEDICARE: DR. JONNIE KAY GILBERT TAYLOR D.C.

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	111NX0800X	Orthopedic Chiropractor	1030	MT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00119675	OTHER	MT	MEDICARE RAIL ROAD

General Provider Information

NPI Number	:	1265581359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONNIE KAY GILBERT TAYLOR D.C.

Provider Business Mailing Address
First Line	:	1308 12TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4604
Country	:	US
Telephone Number	:	406-453-1369
Fax Number	:	406-453-8887

Provider Business Practice Location Address
First Line	:	1308 12TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-4604
Country	:	US
Telephone Number	:	406-453-1369
Fax Number	:	406-453-8887

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/09/2007

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