1154353985 NPI number — TAYLOR CHIROPRACTIC, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154353985 NPI number — TAYLOR CHIROPRACTIC, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR CHIROPRACTIC, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154353985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 411293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60641-1293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-725-5835
Provider Business Mailing Address Fax Number:
773-725-5834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3970 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60641-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-725-5835
Provider Business Practice Location Address Fax Number:
773-725-5834
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ARON
Authorized Official Title or Position:
PRESIDEN
Authorized Official Telephone Number:
773-725-5835

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038-008914 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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