Provider Demographics
NPI:1538130596
Name:TAYLOR-LAMB, MARY ANNE JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:JESSICA
Last Name:TAYLOR-LAMB
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 1:5500 BARTEL RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-8792
Mailing Address - Country:US
Mailing Address - Phone:315-676-4655
Mailing Address - Fax:315-655-4044
Practice Address - Street 1:5500 BARTEL RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-8792
Practice Address - Country:US
Practice Address - Phone:315-676-4655
Practice Address - Fax:315-655-4044
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY58885BMedicare PIN