MEDICARE: THOMAS L TEAL III DC

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	DC5606	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88332S	OTHER		B/C B/S

General Provider Information

NPI Number	:	1518955137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L TEAL III DC

Provider Business Mailing Address
First Line	:	203 N CENTER AVE
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-3114
Country	:	US
Telephone Number	:	325-646-0342
Fax Number	:	325-646-6562

Provider Business Practice Location Address
First Line	:	203 N CENTER AVE
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-3114
Country	:	US
Telephone Number	:	325-646-0342
Fax Number	:	325-646-6552

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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Directions to “ THOMAS L TEAL III DC” Practice Location

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