Provider Demographics
NPI:1568421972
Name:TEETERS, W RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:RICHARD
Last Name:TEETERS
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 1:1353 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3425
Mailing Address - Country:US
Mailing Address - Phone:937-252-4400
Mailing Address - Fax:937-252-4402
Practice Address - Street 1:1353 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3425
Practice Address - Country:US
Practice Address - Phone:937-252-4400
Practice Address - Fax:937-252-4402
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428693Medicaid
OH0428693Medicaid
OH$$$$$$$$$-00OtherBWC
OH0459581Medicare PIN