Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2740 | TX |
NPI | 1003029174 |
---|---|
Provider Name | Dr. Dennis Wayne Teal |
First Address | Livingston, TX 77351-9601 |
Second Address | Livingston, TX 77351-9601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 04/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011140 | (05) | TX |