Provider Demographics
NPI:1578572665
Name:TAYLOR, JOHN BRYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRYAN
Last Name:TAYLOR
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 1:101 E PLUMMER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8047
Mailing Address - Country:US
Mailing Address - Phone:217-483-1551
Mailing Address - Fax:217-483-6294
Practice Address - Street 1:101 E PLUMMER BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8047
Practice Address - Country:US
Practice Address - Phone:217-483-1551
Practice Address - Fax:217-483-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8426897OtherBLUE CROSS BLUE SHIELD
IL560370Medicare ID - Type Unspecified
IL8426897OtherBLUE CROSS BLUE SHIELD