Provider Demographics
NPI:1508313032
Name:TAYLOR PAUL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:TAYLOR PAUL CHIROPRACTIC LLC
Other - Org Name:PERFORMANCE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-384-3236
Mailing Address - Street 1:6512 SPRUCEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7846
Mailing Address - Country:US
Mailing Address - Phone:843-384-3236
Mailing Address - Fax:
Practice Address - Street 1:11872 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAPPINGTON
Practice Address - State:MO
Practice Address - Zip Code:63127-1800
Practice Address - Country:US
Practice Address - Phone:843-384-3236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty