Provider Demographics
NPI:1144357526
Name:TAYLOR, MARK ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1428 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3446
Mailing Address - Country:US
Mailing Address - Phone:904-940-0656
Mailing Address - Fax:
Practice Address - Street 1:2851 EDGEWOOD AVE N
Practice Address - Street 2:SUITE 18
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-1400
Practice Address - Country:US
Practice Address - Phone:904-359-5464
Practice Address - Fax:904-359-5460
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor