Provider Demographics
NPI:1083993737
Name:TAYLOR, JESSICA LEE (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 ELSE TERRACE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-235-1812
Mailing Address - Fax:
Practice Address - Street 1:2131 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5614
Practice Address - Country:US
Practice Address - Phone:410-234-1600
Practice Address - Fax:410-727-4148
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor