Provider Demographics
NPI:1053543033
Name:TAYLOR, CLEVE R (DC)
Entity type:Individual
Prefix:DR
First Name:CLEVE
Middle Name:R
Last Name:TAYLOR
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 1:1100 SPRING ST NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2846
Mailing Address - Country:US
Mailing Address - Phone:404-815-1505
Mailing Address - Fax:
Practice Address - Street 1:1100 SPRING ST NW
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2846
Practice Address - Country:US
Practice Address - Phone:404-815-1505
Practice Address - Fax:404-815-1669
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008510111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation