MEDICARE: W. RICHARD TEETERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	754	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023295482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W. RICHARD TEETERS, LLC

Provider Business Mailing Address
First Line	:	1353 WOODMAN DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-3425
Country	:	US
Telephone Number	:	937-252-4400
Fax Number	:	937-252-4402

Provider Business Practice Location Address
First Line	:	1353 WOODMAN DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-3425
Country	:	US
Telephone Number	:	937-252-4400
Fax Number	:	937-252-4402

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	RICHARD TEETERS
Credential	:	D.C.
Telephone Number	:	937-252-4400

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	06/24/2011

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