Provider Demographics
NPI:1821689605
Name:TAYLOR, BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
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 1:46 ATCHISON PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8003
Mailing Address - Country:US
Mailing Address - Phone:501-291-3164
Mailing Address - Fax:
Practice Address - Street 1:1997 BATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AR
Practice Address - Zip Code:72501-7896
Practice Address - Country:US
Practice Address - Phone:870-613-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor