Provider Demographics
NPI:1114076585
Name:KABETZKE, TEENA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:TEENA
Middle Name:MARIE
Last Name:KABETZKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2426 S CARRIER PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3805
Mailing Address - Country:US
Mailing Address - Phone:972-602-7222
Mailing Address - Fax:972-602-7223
Practice Address - Street 1:2426 S CARRIER PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3805
Practice Address - Country:US
Practice Address - Phone:972-602-7222
Practice Address - Fax:972-602-7223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
604063Medicare PIN