Provider Demographics
NPI:1962000125
Name:TAYLOR, JESSICA DOMINIQUE (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DOMINIQUE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 QUAIL CT
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2048
Mailing Address - Country:US
Mailing Address - Phone:170-857-4926
Mailing Address - Fax:
Practice Address - Street 1:2417 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3134
Practice Address - Country:US
Practice Address - Phone:708-798-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor