Provider Demographics
NPI:1043434582
Name:TEICHEIRA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TEICHEIRA CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:TEICHEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-383-3101
Mailing Address - Street 1:198 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1365
Mailing Address - Country:US
Mailing Address - Phone:541-383-3101
Mailing Address - Fax:541-383-3101
Practice Address - Street 1:198 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1365
Practice Address - Country:US
Practice Address - Phone:541-383-3101
Practice Address - Fax:541-383-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1043434582Medicare PIN