Provider Demographics
NPI:1003029174
Name:TEAL, DENNIS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WAYNE
Last Name:TEAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 U S HIGHWAY 190 W
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9601
Mailing Address - Country:US
Mailing Address - Phone:936-327-5572
Mailing Address - Fax:936-327-5573
Practice Address - Street 1:2000 U S HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9601
Practice Address - Country:US
Practice Address - Phone:936-327-5572
Practice Address - Fax:936-327-5573
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011140Medicaid
TXTXB116087Medicare PIN