Provider Demographics
NPI:1952787467
Name:TAYLOR, TAYLOR ALEXANDRA
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXANDRA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013B WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-1503
Mailing Address - Country:US
Mailing Address - Phone:703-536-5900
Mailing Address - Fax:703-536-5902
Practice Address - Street 1:6013B WILSON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-1503
Practice Address - Country:US
Practice Address - Phone:703-536-5900
Practice Address - Fax:703-536-5902
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor