Provider Demographics
NPI:1467499194
Name:PRINCIPLED PHYSICIANS AND REHABILITATION CENTER OF LAWRENCEBURG
Entity Type:Organization
Organization Name:PRINCIPLED PHYSICIANS AND REHABILITATION CENTER OF LAWRENCEBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TEIFKE
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:812-539-2900
Mailing Address - Street 1:401 W EADS PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1374
Mailing Address - Country:US
Mailing Address - Phone:812-539-2900
Mailing Address - Fax:812-539-2999
Practice Address - Street 1:401 W EADS PKWY STE 320
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1374
Practice Address - Country:US
Practice Address - Phone:812-539-2900
Practice Address - Fax:812-539-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002022A111N00000X
OH2006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200337770AMedicaid
IN250700Medicare PIN