Provider Demographics
NPI:1902309693
Name:FREDERICK, TAYLOR (DC)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10310 MONCREIFFE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7814
Mailing Address - Country:US
Mailing Address - Phone:561-358-1451
Mailing Address - Fax:
Practice Address - Street 1:10310 MONCREIFFE RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7814
Practice Address - Country:US
Practice Address - Phone:561-358-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor