Provider Demographics
NPI:1477510048
Name:TAYLOR, THEA M (DC)
Entity Type:Individual
Prefix:MISS
First Name:THEA
Middle Name:M
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 1:618 W MAIN ST
Mailing Address - Street 2:#102
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3773
Mailing Address - Country:US
Mailing Address - Phone:281-332-4476
Mailing Address - Fax:
Practice Address - Street 1:618 W MAIN ST
Practice Address - Street 2:#102
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3773
Practice Address - Country:US
Practice Address - Phone:281-332-4476
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10254111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V3120OtherBLUE CROSS/BLUE SHEILD TX