Provider Demographics
NPI:1598848616
Name:HOBAN, TERESA M (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:HOBAN
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 1:298 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1834
Mailing Address - Country:US
Mailing Address - Phone:315-536-1093
Mailing Address - Fax:
Practice Address - Street 1:298 LAKE ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1834
Practice Address - Country:US
Practice Address - Phone:315-536-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008881-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB1221Medicare ID - Type Unspecified