Provider Demographics
NPI:1336737105
Name:LUSTER, TAYLOR (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:LUSTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 GOLD CANYON DR APT 1312
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3664
Mailing Address - Country:US
Mailing Address - Phone:210-993-4040
Mailing Address - Fax:
Practice Address - Street 1:18402 US HIGHWAY 281 N STE 109
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-7606
Practice Address - Country:US
Practice Address - Phone:210-993-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14505111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition