MEDICARE: TEAL HEALTH CLINIC. INC.

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	CHIR001617	GA

General Provider Information

NPI Number	:	1215250592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAL HEALTH CLINIC. INC.

Provider Business Mailing Address
First Line	:	8605 CARTERSVILLE HWY
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-1394
Country	:	US
Telephone Number	:	770-445-5779
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 W MEMORIAL DR
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-4114
Country	:	US
Telephone Number	:	770-445-5779
Fax Number	:	770-445-5779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLEAVELAND JOE TEAL
Credential	:	D.C.
Telephone Number	:	770-445-1190

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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