Provider Demographics
NPI:1619907276
Name:MARSHALL, TERESA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:MARSHALL
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 1:1084 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-9716
Mailing Address - Country:US
Mailing Address - Phone:952-361-6217
Mailing Address - Fax:
Practice Address - Street 1:31 NAVAHO AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4812
Practice Address - Country:US
Practice Address - Phone:507-345-4035
Practice Address - Fax:507-345-4122
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU39541Medicare UPIN
MN350001411Medicare ID - Type Unspecified