Provider Demographics
NPI:1154449874
Name:TAYLOR, GREGORY D (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
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:PO BOX 50256
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-0256
Mailing Address - Country:US
Mailing Address - Phone:214-941-4903
Mailing Address - Fax:214-941-4904
Practice Address - Street 1:211 E CLARENDON DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-2914
Practice Address - Country:US
Practice Address - Phone:214-941-4903
Practice Address - Fax:214-941-4904
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7196111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU64464Medicare UPIN