=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659775203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEICHMEIER GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2014
-----------------------------------------------------
Last Update Date | 10/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 985 E US HIGHWAY 54
-----------------------------------------------------
City | CAMDENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65020-6838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-440-4838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3538
-----------------------------------------------------
City | CAMDENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65020-3538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | TERRY W TEICHMEIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-440-4838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2014036017
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------