Provider Demographics
NPI:1194809228
Name:DAVIDSON, TERESA (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:EDINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1415 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1838
Mailing Address - Country:US
Mailing Address - Phone:812-256-7930
Mailing Address - Fax:812-256-7931
Practice Address - Street 1:1415 MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-1838
Practice Address - Country:US
Practice Address - Phone:812-256-7930
Practice Address - Fax:812-256-7931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001510A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000190724OtherBLUE CROSS/BLUE SHIELD
IN44-00154OtherUNITED HEALTHCARE
INP00140879OtherPALMETTO GBA RR MEDICARE
IN000000190724OtherBLUE CROSS/BLUE SHIELD
IN127130Medicare ID - Type Unspecified