Provider Demographics
NPI:1104125228
Name:TAYLOR, CONRAD MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:MARTIN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 ASHFORD DR
Mailing Address - Street 2:APT. 1823
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7842
Mailing Address - Country:US
Mailing Address - Phone:719-330-6666
Mailing Address - Fax:
Practice Address - Street 1:3900 CYPRESS STREET
Practice Address - Street 2:SUITE 13
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7400
Practice Address - Country:US
Practice Address - Phone:318-396-5558
Practice Address - Fax:318-396-9119
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor