Provider Demographics
NPI:1306258389
Name:KOREN, TEDD (DC)
Entity type:Individual
Prefix:DR
First Name:TEDD
Middle Name:
Last Name:KOREN
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:PO BOX 665
Mailing Address - Street 2:301 WOOD SPRING ROAD
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0665
Mailing Address - Country:US
Mailing Address - Phone:215-699-7906
Mailing Address - Fax:
Practice Address - Street 1:301 WOOD SPRING ROAD
Practice Address - Street 2:
Practice Address - City:GWYNEDD VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19437-0665
Practice Address - Country:US
Practice Address - Phone:215-699-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
156EAST57OtherPRIVATE PRACTISE