Provider Demographics
NPI:1346526282
Name:CORNISH, TEANDRA LAMESA (DC)
Entity Type:Individual
Prefix:
First Name:TEANDRA
Middle Name:LAMESA
Last Name:CORNISH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 GREENVILLE AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2941
Mailing Address - Country:US
Mailing Address - Phone:214-750-9600
Mailing Address - Fax:214-750-9601
Practice Address - Street 1:5500 GREENVILLE AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-2941
Practice Address - Country:US
Practice Address - Phone:214-750-9600
Practice Address - Fax:214-750-9601
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor