Provider Demographics
NPI:1023285285
Name:TAYLOR, GRANT EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:EDWARD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21222 VIKING WAY NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9491
Mailing Address - Country:US
Mailing Address - Phone:360-779-7923
Mailing Address - Fax:360-779-9124
Practice Address - Street 1:21222 VIKING WAY NW
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9491
Practice Address - Country:US
Practice Address - Phone:360-779-7923
Practice Address - Fax:360-779-9124
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0002749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB11143Medicare PIN