Provider Demographics
NPI:1467752329
Name:TAYLOR, JEREMY J (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
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 1:2600 ALEMEDA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4042
Mailing Address - Country:US
Mailing Address - Phone:817-523-9590
Mailing Address - Fax:817-523-8666
Practice Address - Street 1:2600 ALEMEDA ST STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4042
Practice Address - Country:US
Practice Address - Phone:817-523-9590
Practice Address - Fax:817-523-8666
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11601111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor