Provider Demographics
NPI:1578265310
Name:BURR, TEYLOR G (DC)
Entity Type:Individual
Prefix:
First Name:TEYLOR
Middle Name:G
Last Name:BURR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 GREEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3131
Mailing Address - Country:US
Mailing Address - Phone:801-550-3498
Mailing Address - Fax:
Practice Address - Street 1:2195 W 5400 S STE 105
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1433
Practice Address - Country:US
Practice Address - Phone:801-601-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6101036-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty