=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689714412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESE M NASER D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 DURHAM RD
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06443-2674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-558-2847
-----------------------------------------------------
Fax | 203-245-4058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 213
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06443-0213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-558-2847
-----------------------------------------------------
Fax | 203-245-4058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 001449
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------