Provider Demographics
NPI:1780283424
Name:DOUGHERTY, TAYLOR PAIGE (DC, CD(DONA))
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:PAIGE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:DC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 KILBURN RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1608
Mailing Address - Country:US
Mailing Address - Phone:443-206-4916
Mailing Address - Fax:
Practice Address - Street 1:6 SHARPLEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2941
Practice Address - Country:US
Practice Address - Phone:302-476-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13262CH111N00000X
DEF1-00011138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEF1-0011138OtherDELAWARE LICENSE
FL15212OtherDONA INTERNATION DOULA CERTIFICATION
FLCH13262Medicaid