Provider Demographics
NPI:1588660088
Name:TEEPLE, MICHAEL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TEEPLE
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:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-0233
Mailing Address - Country:US
Mailing Address - Phone:913-724-1538
Mailing Address - Fax:913-724-3222
Practice Address - Street 1:15604 PINEHURST DR
Practice Address - Street 2:STE 3A
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-8233
Practice Address - Country:US
Practice Address - Phone:913-724-1538
Practice Address - Fax:913-724-3222
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS125926OtherCOVENTRY
KS25429021OtherBCBS-KC
KS062033OtherBCBS-KS
KS125926OtherCOVENTRY
KSU80807Medicare UPIN