Provider Demographics
NPI:1598761488
Name:SAUNDERS, TERESA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:SAUNDERS
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:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-0672
Mailing Address - Country:US
Mailing Address - Phone:734-449-8564
Mailing Address - Fax:
Practice Address - Street 1:8505 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9248
Practice Address - Country:US
Practice Address - Phone:734-449-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4786745Medicaid
MIP60861OtherBLUE CARE NETWORK
MI1498568Medicaid
MI126937OtherSELECT CARE PPO
MI4786745Medicaid
MIP60861OtherBLUE CARE NETWORK