Provider Demographics
NPI:1063699320
Name:CARDWELL, TERESA KRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:KRISTINE
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 POINCIANA ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4533
Mailing Address - Country:US
Mailing Address - Phone:305-947-1515
Mailing Address - Fax:305-947-0015
Practice Address - Street 1:428 POINCIANA ISLAND DR
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4533
Practice Address - Country:US
Practice Address - Phone:305-947-1515
Practice Address - Fax:305-947-0015
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5940111NN1001X
LA857111NN1001X
AL1258111NN1001X
TX5142111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition