Provider Demographics
NPI:1285348078
Name:TAYLOR, BLAKE E (DC)
Entity type:Individual
Prefix:MR
First Name:BLAKE
Middle Name:E
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 1:38 RIDGEWOOD PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9486
Mailing Address - Country:US
Mailing Address - Phone:270-821-9020
Mailing Address - Fax:270-821-9750
Practice Address - Street 1:38 RIDGEWOOD PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9486
Practice Address - Country:US
Practice Address - Phone:270-821-9020
Practice Address - Fax:270-821-9750
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282632111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor