Provider Demographics
NPI:1366769606
Name:TELLER CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:TELLER CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-588-4864
Mailing Address - Street 1:9755 N 90TH ST
Mailing Address - Street 2:SUITE A203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5046
Mailing Address - Country:US
Mailing Address - Phone:480-588-4864
Mailing Address - Fax:480-306-7228
Practice Address - Street 1:9755 N 90TH ST
Practice Address - Street 2:SUITE A203
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5046
Practice Address - Country:US
Practice Address - Phone:480-588-4864
Practice Address - Fax:480-306-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty