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General NPI Number Information
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NPI Number | 1225623374
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Entity Type | Individual
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Provider Name | BRANDON TAYLOR JACOB DC
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Gender | Male
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 3301 SCHOOLHOUSE LN
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City | HARRISBURG
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State | PA
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Zip | 17109-4726
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Country | US
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Telephone | 717-652-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 111 ROUTE 70 E APT 5242
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City | MARLTON
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State | NJ
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Zip | 08053-2260
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Country | US
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Telephone | 609-781-4053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC011626
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License Number State | PA
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