Healthcare Provider Details

I. General information

NPI: 1588146310
Provider Name (Legal Business Name): TAYLOR JAMES PREMER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PROFESSIONAL PKWY
TROY MO
63379-2822
US

IV. Provider business mailing address

34 PROFESSIONAL PKWY
TROY MO
63379-2822
US

V. Phone/Fax

Practice location:
  • Phone: 636-356-5557
  • Fax:
Mailing address:
  • Phone: 636-356-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2018031824
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: