Provider Demographics
NPI:1558648493
Name:TRITAPOE, TEAL LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:TEAL
Middle Name:LEIGH
Last Name:TRITAPOE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TEAL
Other - Middle Name:LEIGH
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1373
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-1373
Mailing Address - Country:US
Mailing Address - Phone:304-999-2027
Mailing Address - Fax:
Practice Address - Street 1:70 PRESIDENTS ST
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719-0437
Practice Address - Country:US
Practice Address - Phone:304-813-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03670111N00000X
WV1034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor