Provider Demographics
NPI:1558693614
Name:VESTAL, TERESA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:VESTAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 COMMONS CIR STE A
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9528
Mailing Address - Country:US
Mailing Address - Phone:405-577-6268
Mailing Address - Fax:405-577-6371
Practice Address - Street 1:1809 COMMONS CIR STE A
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9528
Practice Address - Country:US
Practice Address - Phone:405-577-6268
Practice Address - Fax:405-577-6371
Is Sole Proprietor?:No
Enumeration Date:2010-01-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3965111N00000X
TX11365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3965OtherOKLAHOMA CHIROPRACTIC BOARD OF EXAMINERS LICENSE