Provider Demographics
NPI:1063620441
Name:RICE, TED DAIL (DC)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:DAIL
Last Name:RICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S HIGHWAY 29
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-1454
Mailing Address - Country:US
Mailing Address - Phone:850-968-1187
Mailing Address - Fax:850-968-1775
Practice Address - Street 1:439 S HIGHWAY 29
Practice Address - Street 2:SUITE 3
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-1454
Practice Address - Country:US
Practice Address - Phone:850-968-1187
Practice Address - Fax:850-968-1775
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU61027Medicare UPIN
FLK2578Medicare ID - Type UnspecifiedMEDICARE ID