Provider Demographics
NPI:1932121043
Name:TAYLOR, MAURICE WILBUR (DC)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:WILBUR
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 1:1240 ZION RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-2513
Mailing Address - Country:US
Mailing Address - Phone:814-355-4141
Mailing Address - Fax:814-355-1654
Practice Address - Street 1:1240 ZION RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-2513
Practice Address - Country:US
Practice Address - Phone:814-355-4141
Practice Address - Fax:814-355-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL 001866-DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor