Provider Demographics
NPI:1790842060
Name:HAZELWOOD, TERESA DARLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DARLENE
Last Name:HAZELWOOD
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 1:5055 HWY N STE. #105
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8031
Mailing Address - Country:US
Mailing Address - Phone:314-402-5910
Mailing Address - Fax:636-235-4200
Practice Address - Street 1:5055 HWY N STE. #105
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8031
Practice Address - Country:US
Practice Address - Phone:314-402-5910
Practice Address - Fax:636-235-4200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104898OtherGHP
MO333832OtherHEALTHLINK
MO151771OtherBC BS OF MO
MO4400706OtherUHC
MOMA4420001Medicare PIN
MO31927Medicare ID - Type UnspecifiedMEDICARE
MO104898OtherGHP
MOU68913Medicare UPIN