Provider Demographics
NPI:1114465507
Name:MASON, TAYLOR RE (DC)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:RE
Last Name:MASON
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 1:6853 MOUNTAIN TOP LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1951
Mailing Address - Country:US
Mailing Address - Phone:719-301-5781
Mailing Address - Fax:
Practice Address - Street 1:13860 GLENEAGLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3214
Practice Address - Country:US
Practice Address - Phone:719-301-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007766111N00000X
AL2527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor