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General NPI Number Information
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NPI Number | 1215250592
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Entity Type | Organization
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Legal Business Name | TEAL HEALTH CLINIC. INC.
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 431 W MEMORIAL DR
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City | DALLAS
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State | GA
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Zip | 30132-4114
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Country | US
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Telephone | 770-445-5779
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Fax | 770-445-5779
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Provider Business Mailing Address
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Address Line | 8605 CARTERSVILLE HWY
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City | DALLAS
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State | GA
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Zip | 30132-1394
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Country | US
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Telephone | 770-445-5779
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLEAVELAND JOE TEAL
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Credential | D.C.
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Telephone | 770-445-1190
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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 | CHIR001617
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License Number State | GA
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