Provider Demographics
NPI:1952412819
Name:TAYLOR SPORT CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TAYLOR SPORT CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:THEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-332-4476
Mailing Address - Street 1:618 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3772
Mailing Address - Country:US
Mailing Address - Phone:281-332-4476
Mailing Address - Fax:281-332-4608
Practice Address - Street 1:618 W MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3772
Practice Address - Country:US
Practice Address - Phone:281-332-4476
Practice Address - Fax:281-332-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10254111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty