Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2870012 | WI |
N | 111NS0005X | Chiropractic Sports Physician | 2870-012 | WI |
NPI | 1326185331 |
---|---|
Provider Name | Jay C Taylor |
First Address | Baraboo, WI 53913-1166 |
Second Address | Mauston, WI 53948-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 28/09/2016 |