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General NPI Number Information
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NPI Number | 1730600131
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Entity Type | Organization
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Legal Business Name | TEACHWORTH CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 07/06/2017
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Provider Practice Location Address
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Address Line | 3056 HIGHWAY 14
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City | SUPERIOR
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State | NE
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Zip | 68978-5001
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Country | US
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Telephone | 785-875-3010
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Fax | 785-875-4746
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Provider Business Mailing Address
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Address Line | 1435 N CENTRAL AVE
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City | SUPERIOR
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State | NE
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Zip | 68978-1021
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Country | US
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Telephone | 785-875-3010
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Fax | 785-875-4746
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. LANCE L TEACHWORTH
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Credential | DC
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Telephone | 785-875-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01-04366
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License Number State | KS
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