MEDICARE: TERESA ROUSSEAU D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6760	TX

General Provider Information

NPI Number	:	1093833899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ROUSSEAU D.C.

Provider Business Mailing Address
First Line	:	7716 FERGUSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6350
Country	:	US
Telephone Number	:	214-330-7246
Fax Number	:	214-330-7246

Provider Business Practice Location Address
First Line	:	7716 FERGUSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-6350
Country	:	US
Telephone Number	:	214-330-7246
Fax Number	:	214-330-7246

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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