Provider Demographics
NPI:1720318645
Name:JLAAT
Entity Type:Organization
Organization Name:JLAAT
Other - Org Name:TAYLOR FAMILY WELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-233-4055
Mailing Address - Street 1:4114 BROOKSTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8622
Mailing Address - Country:US
Mailing Address - Phone:937-233-4055
Mailing Address - Fax:937-233-4077
Practice Address - Street 1:8501 OLD TROY PIKE
Practice Address - Street 2:SUITE 190
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1054
Practice Address - Country:US
Practice Address - Phone:937-233-4055
Practice Address - Fax:937-233-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJT9386591OtherMEDICARE PTAN
OHJT9386591OtherMEDICARE PTAN