Provider Demographics
NPI:1649583600
Name:TEEL CHIROPRACTIC CLINIC, LTD.
Entity Type:Organization
Organization Name:TEEL CHIROPRACTIC CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-439-7171
Mailing Address - Street 1:509 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1328
Mailing Address - Country:US
Mailing Address - Phone:618-439-7171
Mailing Address - Fax:618-439-6151
Practice Address - Street 1:509 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1328
Practice Address - Country:US
Practice Address - Phone:618-439-7171
Practice Address - Fax:618-439-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009609261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2832008OtherBLUE CROSS BLUE SHIELD
226906OtherGHP
730179OtherCIGNA
626640OtherHEALTH LINK
626640OtherHEALTH LINK
IL206899Medicare PIN