Provider Demographics
NPI:1710674312
Name:TEASLEY, JOHN GLENDON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GLENDON
Last Name:TEASLEY
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 1:10990 CHICAGO DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-8100
Mailing Address - Country:US
Mailing Address - Phone:616-546-3500
Mailing Address - Fax:
Practice Address - Street 1:10990 CHICAGO DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-8100
Practice Address - Country:US
Practice Address - Phone:616-546-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14505111N00000X
MI2301401458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor