MEDICARE: DR. MICHAEL JOSEPH TEEPLE DC

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	111N00000X	Chiropractor	01-04560	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	125926	OTHER	KS	COVENTRY
2	25429021	OTHER	KS	BCBS-KC
3	062033	OTHER	KS	BCBS-KS

General Provider Information

NPI Number	:	1588660088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH TEEPLE DC

Provider Business Mailing Address
First Line	:	PO BOX 233
Second Line	:
City	:	BASEHOR
State	:	KS
Zip	:	66007-0233
Country	:	US
Telephone Number	:	913-724-1538
Fax Number	:	913-724-3222

Provider Business Practice Location Address
First Line	:	15604 PINEHURST DR
Second Line	:	STE 3A
City	:	BONNER SPRINGS
State	:	KS
Zip	:	66012-8233
Country	:	US
Telephone Number	:	913-724-1538
Fax Number	:	913-724-3222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	04/15/2021

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