Provider Demographics
NPI:1730127143
Name:NEISS, THERESA M (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:NEISS
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 1:16603 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2660
Mailing Address - Country:US
Mailing Address - Phone:804-883-3000
Mailing Address - Fax:804-883-3060
Practice Address - Street 1:16603 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2660
Practice Address - Country:US
Practice Address - Phone:804-883-3000
Practice Address - Fax:804-883-3060
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1046960OtherASHN
VA180192OtherANTHEM BCBS
VA0007040764OtherAETNA (AHP)
VA62413Other1ST HEALTH
VA62413Other1ST HEALTH
VA0007040764OtherAETNA (AHP)