Provider Demographics
NPI:1326185331
Name:TAYLOR, JAY C (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
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 1:550 W MAPLE ST
Mailing Address - Street 2:# 201
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1166
Mailing Address - Country:US
Mailing Address - Phone:608-355-4100
Mailing Address - Fax:608-355-4107
Practice Address - Street 1:522 STATE ROAD 82
Practice Address - Street 2:SUITE B
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1450
Practice Address - Country:US
Practice Address - Phone:608-847-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2870-012111NS0005X
WI2870012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician