Provider Demographics
NPI:1336947019
Name:MIRACLE, TAYLOR ANN (DC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:MIRACLE
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 BLUEWATER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5311
Mailing Address - Country:US
Mailing Address - Phone:661-547-0642
Mailing Address - Fax:
Practice Address - Street 1:30 ACOMA BLVD S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5957
Practice Address - Country:US
Practice Address - Phone:928-680-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor