Provider Demographics
NPI:1346519030
Name:DREW, TERI A (DC)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:A
Last Name:DREW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:A
Other - Last Name:BROADWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3001 COMMUNICATIONS PKWY
Mailing Address - Street 2:#515
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8833
Mailing Address - Country:US
Mailing Address - Phone:214-417-8138
Mailing Address - Fax:
Practice Address - Street 1:2406 N HASKELL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3708
Practice Address - Country:US
Practice Address - Phone:214-370-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-25
Last Update Date:2011-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor