Healthcare Provider Details

I. General information

NPI: 1194809228
Provider Name (Legal Business Name): TERESA DAVIDSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA EDINGTON D.C.

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 MARKET ST
CHARLESTOWN IN
47111-1838
US

IV. Provider business mailing address

1415 MARKET ST
CHARLESTOWN IN
47111-1838
US

V. Phone/Fax

Practice location:
  • Phone: 812-256-7930
  • Fax: 812-256-7931
Mailing address:
  • Phone: 812-256-7930
  • Fax: 812-256-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001510A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: