Provider Demographics
NPI:1942210588
Name:PRINCE, TERI A (DC)
Entity Type:Individual
Prefix:DR
First Name:TERI
Middle Name:A
Last Name:PRINCE
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 1:108 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2025
Mailing Address - Country:US
Mailing Address - Phone:270-753-4880
Mailing Address - Fax:270-759-4888
Practice Address - Street 1:108 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2025
Practice Address - Country:US
Practice Address - Phone:270-753-4880
Practice Address - Fax:270-759-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4064111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000069313OtherANTHEM BLUE CROSS & BLUE
KY6075301Medicare ID - Type Unspecified