Provider Demographics
NPI:1669133377
Name:FRACCASTORO, TAYLOR NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:NICOLE
Last Name:FRACCASTORO
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 1:3500 NORTH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2466
Mailing Address - Country:US
Mailing Address - Phone:936-564-4000
Mailing Address - Fax:936-564-4002
Practice Address - Street 1:3500 NORTH ST STE 2
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2466
Practice Address - Country:US
Practice Address - Phone:936-564-4000
Practice Address - Fax:936-564-4002
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty