Provider Demographics
NPI:1174743611
Name:TAYLOR CHIROPRACTIC CENTER INC OF JONESBORO
Entity type:Organization
Organization Name:TAYLOR CHIROPRACTIC CENTER INC OF JONESBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-932-5333
Mailing Address - Street 1:3009 EAST NETTLETON
Mailing Address - Street 2:SUITE E
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-932-5333
Mailing Address - Fax:870-932-5333
Practice Address - Street 1:3009 EAST NETTLETON
Practice Address - Street 2:SUITE E
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-5333
Practice Address - Fax:870-932-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR965111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59886OtherBLUE CROSS BLUE SHIELD
=========OtherFED TAX ID NUMBER ALL OTH
=========OtherFED TAX ID NUMBER ALL OTH
T75518Medicare UPIN