Provider Demographics
NPI:1205556842
Name:JACOB D TAYLOR
Entity type:Organization
Organization Name:JACOB D TAYLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-525-4524
Mailing Address - Street 1:2323 SHALLOWFORD RD STE 105C
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2000
Mailing Address - Country:US
Mailing Address - Phone:678-525-4524
Mailing Address - Fax:678-547-3108
Practice Address - Street 1:2323 SHALLOWFORD RD STE 105C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2000
Practice Address - Country:US
Practice Address - Phone:678-525-4524
Practice Address - Fax:678-547-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty