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General NPI Number Information
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NPI Number | 1720318645
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Entity Type | Organization
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Legal Business Name | JLAAT
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 8501 OLD TROY PIKE SUITE 190
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-1054
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Country | US
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Telephone | 937-233-4055
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Fax | 937-233-4077
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Provider Business Mailing Address
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Address Line | 4114 BROOKSTON DR
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City | SPRINGFIELD
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State | OH
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Zip | 45502-8622
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Country | US
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Telephone | 937-233-4055
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Fax | 937-233-4077
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. LEIGH A. TAYLOR
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Credential | D.C.
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Telephone | 937-233-4055
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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 | 3455
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License Number State | OH
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