Provider Demographics
NPI:1063461952
Name:VINING, TERESA KIMBERLY (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:KIMBERLY
Last Name:VINING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 ARBOR BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-9734
Mailing Address - Country:US
Mailing Address - Phone:814-251-5301
Mailing Address - Fax:814-643-6115
Practice Address - Street 1:613 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1721
Practice Address - Country:US
Practice Address - Phone:814-643-2616
Practice Address - Fax:814-643-6115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006548L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001871029001Medicaid
PA023191Medicare ID - Type Unspecified