Provider Demographics
NPI:1578557617
Name:TAYLOR, KELLY L (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:TAYLOR
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 1:116 RIDGE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-8345
Mailing Address - Country:US
Mailing Address - Phone:412-378-0057
Mailing Address - Fax:
Practice Address - Street 1:11616 FRANKSTOWN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3319
Practice Address - Country:US
Practice Address - Phone:412-704-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1601629OtherBCBS INDIVIDUA
PA12137700OtherFEDERAL EMPLOYEES WC
PA1618705OtherBCBS GROUP
PA3645987OtherAETNA
PA201066981OtherCOMMERCIAL PAYORS
PA1601629OtherBCBS INDIVIDUA
PA0801685Medicare ID - Type UnspecifiedMEDICARE GROUP