Provider Demographics
NPI:1679585418
Name:TAYLOR, FREDERIC HOLLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:HOLLAND
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 1:909 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3809
Mailing Address - Country:US
Mailing Address - Phone:512-303-9995
Mailing Address - Fax:512-332-0880
Practice Address - Street 1:909 MAIN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3809
Practice Address - Country:US
Practice Address - Phone:512-303-9995
Practice Address - Fax:512-332-0880
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00257HMedicare ID - Type Unspecified