Provider Demographics
NPI:1578780862
Name:TEEL, EDWARD E (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:TEEL
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 1:12008 ACORN CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1421
Mailing Address - Country:US
Mailing Address - Phone:512-436-9283
Mailing Address - Fax:
Practice Address - Street 1:901 ROUND ROCK AVE
Practice Address - Street 2:C-101
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4514
Practice Address - Country:US
Practice Address - Phone:512-246-3366
Practice Address - Fax:512-246-3977
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT79110Medicare UPIN
TX8B9864Medicare ID - Type Unspecified