Provider Demographics
NPI:1982165205
Name:TAYLOR, BRANDON MITCHELL (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MITCHELL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 NEW LONDON CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3393
Mailing Address - Country:US
Mailing Address - Phone:630-229-1438
Mailing Address - Fax:
Practice Address - Street 1:1363 NEW LONDON CT
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-3393
Practice Address - Country:US
Practice Address - Phone:630-229-1438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor