Provider Demographics
NPI:1588129431
Name:ANDERSON, TAYLOR J (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:J
Last Name:ANDERSON
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 1:2325 RANCH WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3324
Mailing Address - Country:US
Mailing Address - Phone:573-629-9238
Mailing Address - Fax:
Practice Address - Street 1:11902 BLUE RIDGE EXT STE O
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1199
Practice Address - Country:US
Practice Address - Phone:913-579-1154
Practice Address - Fax:913-273-0081
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019002478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty