Provider Demographics
NPI:1972940609
Name:TEAGUE, CONSTANCE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARIE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 KARA CT
Mailing Address - Street 2:SUITE A1
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1392
Mailing Address - Country:US
Mailing Address - Phone:816-407-1249
Mailing Address - Fax:816-407-1259
Practice Address - Street 1:2105 KARA CT
Practice Address - Street 2:SUITE A1
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1392
Practice Address - Country:US
Practice Address - Phone:816-407-1249
Practice Address - Fax:816-407-1259
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04649111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation