Provider Demographics
NPI:1699333575
Name:TEASEL CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:TEASEL CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TEASEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-736-7444
Mailing Address - Street 1:8865 BRECKSVILLE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1931
Mailing Address - Country:US
Mailing Address - Phone:440-736-7444
Mailing Address - Fax:
Practice Address - Street 1:8865 BRECKSVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1931
Practice Address - Country:US
Practice Address - Phone:440-736-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1245774850Medicaid