Provider Demographics
NPI:1003233248
Name:TAYLOR, BRIAN DALE
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DALE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:PROFESSIONAL SUITE 973 W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-878-8800
Mailing Address - Fax:312-448-9978
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:PROFESSIONAL SUITE 973 W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-878-8800
Practice Address - Fax:312-448-9978
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist