Provider Demographics
NPI:1598125874
Name:TAYLOR, JACOB DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DONALD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2323 SHALLOWFORD RD STE 105C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2000
Mailing Address - Country:US
Mailing Address - Phone:678-525-4524
Mailing Address - Fax:678-547-3108
Practice Address - Street 1:2323 SHALLOWFORD RD STE 105C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2000
Practice Address - Country:US
Practice Address - Phone:678-525-4524
Practice Address - Fax:678-547-3108
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor