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General NPI Number Information
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NPI Number | 1649583600
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Entity Type | Organization
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Legal Business Name | TEEL CHIROPRACTIC CLINIC, LTD.
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 509 W MAIN ST
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City | BENTON
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State | IL
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Zip | 62812-1328
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Country | US
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Telephone | 618-439-7171
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Fax | 618-439-6151
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Provider Business Mailing Address
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Address Line | 509 W MAIN ST
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City | BENTON
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State | IL
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Zip | 62812-1328
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Country | US
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Telephone | 618-439-7171
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Fax | 618-439-6151
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JULIE SUZANNE TEEL
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Credential | D.C.
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Telephone | 618-439-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 038009609
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License Number State | IL
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