Provider Demographics
NPI:1649228107
Name:DAVIES, TERESA (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:DAVIES
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 1:1240 KEN PRATT BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6300
Mailing Address - Country:US
Mailing Address - Phone:303-684-8380
Mailing Address - Fax:
Practice Address - Street 1:1240 KEN PRATT BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6300
Practice Address - Country:US
Practice Address - Phone:303-684-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800115Medicare ID - Type UnspecifiedCHIROPRACTOR