Provider Demographics
NPI:1750507885
Name:TAYLOR CHIROPRACTIC & SPORTS INJURY CENTER, S.C.
Entity Type:Organization
Organization Name:TAYLOR CHIROPRACTIC & SPORTS INJURY CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-588-7555
Mailing Address - Street 1:153 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588
Mailing Address - Country:US
Mailing Address - Phone:608-588-7555
Mailing Address - Fax:608-588-7490
Practice Address - Street 1:153 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588
Practice Address - Country:US
Practice Address - Phone:608-588-7555
Practice Address - Fax:608-588-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2870111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty