Provider Demographics
NPI:1558581058
Name:TAYLOR, NOEL A
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 WILLIAMSBURG WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3055
Mailing Address - Country:US
Mailing Address - Phone:812-372-5858
Mailing Address - Fax:812-372-7789
Practice Address - Street 1:3925 WILLIAMSBURG WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3055
Practice Address - Country:US
Practice Address - Phone:812-372-5858
Practice Address - Fax:812-372-7789
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001629A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000201288OtherANTHEM BCBS
IN10786578OtherCAQH ID NUMBER
IN10786578OtherCAQH ID NUMBER
IN144200Medicare ID - Type Unspecified