Provider Demographics
NPI:1790102895
Name:SMITH-TEITELBAUM CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:SMITH-TEITELBAUM CHIROPRACTIC INC.
Other - Org Name:TEITELBAUM CHIROPRACTIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-215-4500
Mailing Address - Street 1:26440 LA ALAMEDA
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-215-4500
Mailing Address - Fax:949-348-2396
Practice Address - Street 1:26440 LA ALAMEDA
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-215-4500
Practice Address - Fax:949-348-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19911OtherMEDICARE PTAN
CAWDC27875BMedicare PIN
CAW19911OtherMEDICARE PTAN