Healthcare Provider Details

I. General information

NPI: 1558648493
Provider Name (Legal Business Name): TEAL LEIGH TRITAPOE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TEAL LEIGH GRADY D.C.

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PRESIDENTS ST
FORT ASHBY WV
26719-0437
US

IV. Provider business mailing address

PO BOX 1373
FORT ASHBY WV
26719-1373
US

V. Phone/Fax

Practice location:
  • Phone: 304-813-2198
  • Fax:
Mailing address:
  • Phone: 304-999-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberS03670
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1034
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: