Provider Demographics
NPI:1164455143
Name:TAYLOR CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:TAYLOR CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-925-1080
Mailing Address - Street 1:322 HIGHWAY 80 E
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4726
Mailing Address - Country:US
Mailing Address - Phone:601-925-1080
Mailing Address - Fax:
Practice Address - Street 1:322 HIGHWAY 80 E
Practice Address - Street 2:SUITE D
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4726
Practice Address - Country:US
Practice Address - Phone:601-925-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS457810148AOtherBCBS
MS457810148AOtherBCBS