Provider Demographics
NPI:1295830602
Name:TAYLOR, CECIL EDWIN (DC)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:EDWIN
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 1:323 PAGE BACON RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1669
Mailing Address - Country:US
Mailing Address - Phone:850-243-3993
Mailing Address - Fax:850-243-3993
Practice Address - Street 1:323 PAGE BACON RD
Practice Address - Street 2:SUITE 16
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1669
Practice Address - Country:US
Practice Address - Phone:850-243-3993
Practice Address - Fax:850-243-3993
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1415111N00000X
CO1320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
70812Medicare ID - Type Unspecified
T55054Medicare UPIN