Provider Demographics
NPI:1831146257
Name:TAYLOR, VIRGIL ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:ROY
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 1:322 HIGHWAY 80 E
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4726
Mailing Address - Country:US
Mailing Address - Phone:601-925-1080
Mailing Address - Fax:601-925-0683
Practice Address - Street 1:322 HIGHWAY 80 E
Practice Address - Street 2:SUITE D
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4726
Practice Address - Country:US
Practice Address - Phone:601-925-1080
Practice Address - Fax:601-925-0683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7585368OtherAETNA
MS7585368OtherAETNA