Provider Demographics
NPI:1154353985
Name:TAYLOR CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:TAYLOR CHIROPRACTIC, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-725-5835
Mailing Address - Street 1:PO BOX 411293
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1293
Mailing Address - Country:US
Mailing Address - Phone:773-725-5835
Mailing Address - Fax:773-725-5834
Practice Address - Street 1:3970 N MILWAUKEE AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2703
Practice Address - Country:US
Practice Address - Phone:773-725-5835
Practice Address - Fax:773-725-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208694Medicare ID - Type UnspecifiedPROVIDER #