1235168147 NPI number — DR. TIFFANY DIANE TAYLOR DC, APC

Table of content: DR. TIFFANY DIANE TAYLOR DC, APC (NPI 1235168147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235168147 NPI number — DR. TIFFANY DIANE TAYLOR DC, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
TIFFANY
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, APC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR-MURRISH
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC, APC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235168147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1514
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88260-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-739-2225
Provider Business Mailing Address Fax Number:
575-739-0039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88260-4020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-739-2225
Provider Business Practice Location Address Fax Number:
575-739-0039
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9244 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1658 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1427079433 . This is a "BACK IN MOTION NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1658 . This is a "DR MURRISH NM LICENSE NR" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 9244 . This is a "DR MURRISH TX LICENSE NR." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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