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General NPI Number Information
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NPI Number | 1942444708
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Entity Type | Organization
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Legal Business Name | NETWORK WELLNESS CENTER OF PRESCOTT
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 119 GROVE AVE SUITE D
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City | PRESCOTT
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State | AZ
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Zip | 86301-2902
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Country | US
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Telephone | 928-771-8590
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Fax |
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Provider Business Mailing Address
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Address Line | 119 GROVE AVE SUITE D
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City | PRESCOTT
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State | AZ
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Zip | 86301-2902
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Country | US
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Telephone | 928-771-8590
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. STEVEN M. TEAGARDEN
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Credential | D.C.
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Telephone | 928-771-8590
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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 | AZ5673
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License Number State | AZ
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