Provider Demographics
NPI:1326162322
Name:TAYLOR, EILEEN MARY (DC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
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 1:182 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3404
Mailing Address - Country:US
Mailing Address - Phone:631-264-4705
Mailing Address - Fax:631-264-4705
Practice Address - Street 1:182 MERRICK RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3404
Practice Address - Country:US
Practice Address - Phone:631-264-4705
Practice Address - Fax:631-264-4705
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006859-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4936-1Medicare ID - Type Unspecified