Provider Demographics
NPI:1568603215
Name:TAYLOR FAMILY CHIROPRACTIC OFFICE, PLLC
Entity Type:Organization
Organization Name:TAYLOR FAMILY CHIROPRACTIC OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEVI
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-248-1388
Mailing Address - Street 1:2403 CUMBERLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1531
Mailing Address - Country:US
Mailing Address - Phone:606-248-1388
Mailing Address - Fax:606-248-6890
Practice Address - Street 1:2403 CUMBERLAND AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1531
Practice Address - Country:US
Practice Address - Phone:606-248-1388
Practice Address - Fax:606-248-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3484111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001691Medicaid
KY85001691Medicaid
KYT-78561Medicare UPIN