Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4599 | OH |
NPI | 1346600319 |
---|---|
Provider Name | Dr. Chad Teague |
First Address | Mentor, OH 44060-1865 |
Second Address | Mentor, OH 44060-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2016 |
Last Update Date | 03/03/2016 |