Provider Demographics
NPI:1518137090
Name:TEDDY ALBERT FARIAS
Entity Type:Organization
Organization Name:TEDDY ALBERT FARIAS
Other - Org Name:PREMIER CHIROPRACTIC & ACUPUNCTURE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-497-6143
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016211111N00000X
MO2008002550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty