Provider Demographics
NPI:1518955137
Name:TEAL, THOMAS L III (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:TEAL
Suffix:III
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 1:203 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-3114
Mailing Address - Country:US
Mailing Address - Phone:325-646-0342
Mailing Address - Fax:325-646-6562
Practice Address - Street 1:203 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-3114
Practice Address - Country:US
Practice Address - Phone:325-646-0342
Practice Address - Fax:325-646-6552
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
88332SOtherB/C B/S
U09893Medicare UPIN
88332SOtherB/C B/S