Provider Demographics
NPI:1134278872
Name:TAYLOR, ELIZABETH R (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 540369
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0369
Mailing Address - Country:US
Mailing Address - Phone:972-641-7111
Mailing Address - Fax:972-660-1119
Practice Address - Street 1:3125 S CARRIER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3735
Practice Address - Country:US
Practice Address - Phone:972-641-7111
Practice Address - Fax:972-660-1119
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU66132Medicare UPIN
TX8F2648Medicare PIN
TX8X2950OtherBLUE CROSS BLUE SHIELD