Provider Demographics
NPI:1750575205
Name:JASON C TAYLOR DC LLC
Entity type:Organization
Organization Name:JASON C TAYLOR DC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-633-3399
Mailing Address - Street 1:690 E WARNER RD
Mailing Address - Street 2:SUITE113
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3054
Mailing Address - Country:US
Mailing Address - Phone:480-633-3399
Mailing Address - Fax:480-633-5605
Practice Address - Street 1:690 E WARNER RD
Practice Address - Street 2:SUITE 113
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3054
Practice Address - Country:US
Practice Address - Phone:480-633-3399
Practice Address - Fax:480-633-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7539111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101162Medicare PIN
AZV03703Medicare UPIN