Provider Demographics
NPI:1497869135
Name:TAYLOR, K G (DC)
Entity Type:Individual
Prefix:DR
First Name:K
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KERMIT
Other - Middle Name:GALE
Other - Last Name:TAYLOR
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4218 N INTERSTATE 35
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3441
Mailing Address - Country:US
Mailing Address - Phone:940-891-4357
Mailing Address - Fax:940-565-1502
Practice Address - Street 1:4218 N INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3441
Practice Address - Country:US
Practice Address - Phone:940-891-4357
Practice Address - Fax:940-565-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU29469Medicare UPIN
TX603567Medicare ID - Type Unspecified