Provider Demographics
NPI:1770653602
Name:ADAMS, TERI L (DC)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:L
Last Name:ADAMS
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-0002
Mailing Address - Country:US
Mailing Address - Phone:715-684-3344
Mailing Address - Fax:715-684-3345
Practice Address - Street 1:1640 TENTH AVE.
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-0002
Practice Address - Country:US
Practice Address - Phone:715-684-3344
Practice Address - Fax:715-684-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38864500Medicaid
WI38864500Medicaid