Provider Demographics
NPI:1871664730
Name:TEDDER, NICHOLAS THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:TEDDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BRASELTON HWY
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1068
Mailing Address - Country:US
Mailing Address - Phone:770-614-9444
Mailing Address - Fax:
Practice Address - Street 1:3635 BRASELTON HWY
Practice Address - Street 2:SUITE B-2
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1068
Practice Address - Country:US
Practice Address - Phone:770-614-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO007771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor