Provider Demographics
NPI:1164592754
Name:LEVINE, THERESA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1113 S MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410
Mailing Address - Country:US
Mailing Address - Phone:203-250-7246
Mailing Address - Fax:203-250-9355
Practice Address - Street 1:1113 S MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:203-250-7246
Practice Address - Fax:203-250-9355
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86283Medicare UPIN