Provider Demographics
NPI:1467530592
Name:AN, TED S (DC)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:S
Last Name:AN
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 1:18181 MIDWAY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-8103
Mailing Address - Country:US
Mailing Address - Phone:972-307-3007
Mailing Address - Fax:
Practice Address - Street 1:18181 MIDWAY RD STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-8103
Practice Address - Country:US
Practice Address - Phone:972-307-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor