Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2006002027 | MO |
N | 111NS0005X | Chiropractic Sports Physician | 5025 | KS |
NPI | 1144424946 |
---|---|
Provider Name | Dr. Thomas Lee Teter Jr |
First Address | Kansas City, MO 64112-1509 |
Second Address | Kansas City, MO 64112-1509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 31/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2006002027 | LICENSE (01) | MO |
5025 | KS LICENSE FOR DC (01) | KS |