Provider Demographics
NPI:1750628152
Name:ROBOTHAM, TERESA (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:ROBOTHAM
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 1:10300 LOUETTA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2121
Mailing Address - Country:US
Mailing Address - Phone:281-370-0075
Mailing Address - Fax:281-370-0626
Practice Address - Street 1:10300 LOUETTA RD STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2121
Practice Address - Country:US
Practice Address - Phone:281-370-0075
Practice Address - Fax:281-370-0626
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor