Provider Demographics
NPI:1790907699
Name:BELL, TISA TERESA (DC)
Entity Type:Individual
Prefix:
First Name:TISA
Middle Name:TERESA
Last Name:BELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:345 S COAST HWY 101
Mailing Address - Street 2:STE L
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-944-7605
Mailing Address - Fax:
Practice Address - Street 1:345 S COAST HWY 101
Practice Address - Street 2:STE L
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-944-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor