Provider Demographics
NPI:1336660273
Name:TAYLOR MADE INTEGRATIVE THERAPY
Entity type:Organization
Organization Name:TAYLOR MADE INTEGRATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-523-9590
Mailing Address - Street 1:2600 ALEMEDA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4042
Mailing Address - Country:US
Mailing Address - Phone:817-523-9590
Mailing Address - Fax:817-523-8666
Practice Address - Street 1:2600 ALEMEDA ST STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4042
Practice Address - Country:US
Practice Address - Phone:817-523-9590
Practice Address - Fax:817-523-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center