Provider Demographics
NPI:1689801078
Name:JOHN F TAYLOR CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:JOHN F TAYLOR CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:530-622-1234
Mailing Address - Street 1:484 MAIN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9102
Mailing Address - Country:US
Mailing Address - Phone:530-622-1234
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9102
Practice Address - Country:US
Practice Address - Phone:530-622-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 17867302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0178670OtherMEDICARE PROVIDER NUMBER