Provider Demographics
NPI:1093747206
Name:SHOWALTER, TED STANLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:STANLEY
Last Name:SHOWALTER
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 1:2605 JENKINS RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1177
Mailing Address - Country:US
Mailing Address - Phone:423-855-5053
Mailing Address - Fax:423-855-5856
Practice Address - Street 1:2605 JENKINS RD
Practice Address - Street 2:STE 2
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1177
Practice Address - Country:US
Practice Address - Phone:423-855-5053
Practice Address - Fax:423-855-5856
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4074012OtherBCBS OF TN
3970195Medicare ID - Type Unspecified