Provider Demographics
NPI:1427226182
Name:FARIAS, TEDDY ALBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:TEDDY
Middle Name:ALBERT
Last Name:FARIAS
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 1:185 WATSON PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1962
Mailing Address - Country:US
Mailing Address - Phone:314-485-5252
Mailing Address - Fax:
Practice Address - Street 1:185 WATSON PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1962
Practice Address - Country:US
Practice Address - Phone:314-485-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor