Provider Demographics
NPI:1629290648
Name:TEAGUE, ALBERT A (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:TEAGUE
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 1:100 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1428
Mailing Address - Country:US
Mailing Address - Phone:937-836-1000
Mailing Address - Fax:937-836-7778
Practice Address - Street 1:100 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1428
Practice Address - Country:US
Practice Address - Phone:937-836-1000
Practice Address - Fax:937-836-7778
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor