Healthcare Provider Details

I. General information

NPI: 1063699320
Provider Name (Legal Business Name): TERESA KRISTINE CARDWELL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 POINCIANA ISLAND DR
SUNNY ISLES BEACH FL
33160-4533
US

IV. Provider business mailing address

428 POINCIANA ISLAND DR
SUNNY ISLES BEACH FL
33160-4533
US

V. Phone/Fax

Practice location:
  • Phone: 305-947-1515
  • Fax: 305-947-0015
Mailing address:
  • Phone: 305-947-1515
  • Fax: 305-947-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH5940
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number857
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1258
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: