Provider Demographics
NPI:1528164811
Name:TAYLOR, EMERSON SAMUEL JR (DC)
Entity type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:SAMUEL
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:EMERSON
Other - Middle Name:SAMUEL
Other - Last Name:TAYLOR
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:25 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-2906
Mailing Address - Country:US
Mailing Address - Phone:513-515-4937
Mailing Address - Fax:844-692-7290
Practice Address - Street 1:25 N MARKET ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2906
Practice Address - Country:US
Practice Address - Phone:513-515-4937
Practice Address - Fax:844-692-7290
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC05921111N00000X
OH2947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2528312Medicaid
OHH249632OtherOH MEDICARE INDIVIDUAL
OH659365OtherACN
OHH249631OtherOHIO MEDICARE GROUP