Provider Demographics
NPI:1346474905
Name:TAYLOR, GREGORY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
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 1960
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-6960
Mailing Address - Country:US
Mailing Address - Phone:850-265-6163
Mailing Address - Fax:850-265-4059
Practice Address - Street 1:1101 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2554
Practice Address - Country:US
Practice Address - Phone:850-265-6163
Practice Address - Fax:850-265-4059
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008461111N00000X
FLCH13942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101367CMedicaid
GA003101367BMedicaid
GA003101367AMedicaid