Provider Demographics
NPI:1699074849
Name:MORTLOCK, TAYLOR DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:DANIEL
Last Name:MORTLOCK
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 1:1303 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1136
Mailing Address - Country:US
Mailing Address - Phone:509-838-2225
Mailing Address - Fax:509-755-2225
Practice Address - Street 1:1303 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1136
Practice Address - Country:US
Practice Address - Phone:509-838-2225
Practice Address - Fax:509-755-2225
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60210509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH60210509OtherWASHINGTON STATE CHIROPRACTOR LICENSE
WACH60210509OtherWASHINGTON STATE CHIROPRACTOR LICENSE