Provider Demographics
NPI:1801153341
Name:TAYLOR, THOMAS A III (BS,DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:BS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CENTRAL AVE UNIT F
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3743
Mailing Address - Country:US
Mailing Address - Phone:843-771-4286
Mailing Address - Fax:843-771-5739
Practice Address - Street 1:820 CENTRAL AVE UNIT F
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3743
Practice Address - Country:US
Practice Address - Phone:843-771-4286
Practice Address - Fax:843-771-4179
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDC3735111N00000X, 111NP0017X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3735Medicaid