MEDICARE: DR. MARY BARKER 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	3218	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085P7	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1346219128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BARKER TAYLOR D.C.

Provider Business Mailing Address
First Line	:	120 CAPCOM AVENUE
Second Line	:	SUITE 104
City	:	WAKE FOREST
State	:	NC
Zip	:	27587
Country	:	US
Telephone Number	:	919-570-9097
Fax Number	:	919-570-9094

Provider Business Practice Location Address
First Line	:	120 CAPCOM AVE
Second Line	:	SUITE 104
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-6530
Country	:	US
Telephone Number	:	919-570-9097
Fax Number	:	919-570-9094

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	01/10/2011

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