Provider Demographics
NPI:1366512162
Name:TAYLOR, VICTORIA JEAN (LIC AC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 YELLOW SULPHUR RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-5672
Mailing Address - Country:US
Mailing Address - Phone:540-953-2977
Mailing Address - Fax:
Practice Address - Street 1:3145 YELLOW SULPHUR RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-5672
Practice Address - Country:US
Practice Address - Phone:540-953-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA031171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist