MEDICARE: DR. MARK ANTHONY TAYLOR D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH8725	FL

General Provider Information

NPI Number	:	1144357526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANTHONY TAYLOR D.C.

Provider Business Mailing Address
First Line	:	1428 HEATHER CT
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3446
Country	:	US
Telephone Number	:	904-940-0656
Fax Number	:

Provider Business Practice Location Address
First Line	:	2851 EDGEWOOD AVE N
Second Line	:	SUITE 18
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-1400
Country	:	US
Telephone Number	:	904-359-5464
Fax Number	:	904-359-5460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/06/2011

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