Provider Demographics
NPI:1306316237
Name:FIEDLER, TEEGAN DAVID (DC, ND)
Entity type:Individual
Prefix:DR
First Name:TEEGAN
Middle Name:DAVID
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 SWEET VALLEY HTS
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4679
Mailing Address - Country:US
Mailing Address - Phone:312-354-0464
Mailing Address - Fax:
Practice Address - Street 1:4004 NORTON LN STE 102
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5966
Practice Address - Country:US
Practice Address - Phone:850-583-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12606111N00000X
IL038-013-137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor