Provider Demographics
NPI:1902837958
Name:TEACHOUT, ERIC BOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BOYD
Last Name:TEACHOUT
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 1:16521 SAN CARLOS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5245
Mailing Address - Country:US
Mailing Address - Phone:239-466-5656
Mailing Address - Fax:239-466-1102
Practice Address - Street 1:16521 SAN CARLOS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5245
Practice Address - Country:US
Practice Address - Phone:239-466-5656
Practice Address - Fax:239-466-1102
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007757111N00000X
FLCH 12025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A350040OtherBCBS
FL4ZZ2MOtherFLORIDABLU
MIP107612OtherBCN
MIU74477Medicare UPIN