Provider Demographics
NPI:1083971261
Name:TAYLOR, BRETT MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MICHAEL
Last Name:TAYLOR
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 1:911 DIX ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-1608
Mailing Address - Country:US
Mailing Address - Phone:269-694-5871
Mailing Address - Fax:
Practice Address - Street 1:911 DIX ST
Practice Address - Street 2:SUITE D
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078-1608
Practice Address - Country:US
Practice Address - Phone:269-694-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor