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General NPI Number Information
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NPI Number | 1154322659
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Entity Type | Individual
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Provider Name | THEODORE W TABER D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 14300 GALLANT FOX LN SUITE 201
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City | BOWIE
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State | MD
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Zip | 20715-4003
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Country | US
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Telephone | 301-352-4500
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Fax | 301-352-6510
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Provider Business Mailing Address
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Address Line | 14300 GALLANT FOX LN SUITE 201
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City | BOWIE
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State | MD
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Zip | 20715-4003
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Country | US
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Telephone | 301-352-4500
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Fax | 301-352-6510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | S01943
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License Number State | MD
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