Provider Demographics
NPI:1255523544
Name:TAYLOR, LOIS J (DC)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1418
Mailing Address - Country:US
Mailing Address - Phone:973-429-9554
Mailing Address - Fax:
Practice Address - Street 1:84 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1418
Practice Address - Country:US
Practice Address - Phone:973-429-9554
Practice Address - Fax:973-429-9079
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00217600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45648Medicare UPIN