Provider Demographics
NPI:1164506473
Name:COFFMAN, TED E (DC)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:E
Last Name:COFFMAN
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 1:18471 E QUEEN CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-3628
Mailing Address - Country:US
Mailing Address - Phone:480-988-7488
Mailing Address - Fax:
Practice Address - Street 1:18471 E QUEEN CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-3628
Practice Address - Country:US
Practice Address - Phone:480-988-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT40887Medicare UPIN