Provider Demographics
NPI:1942328430
Name:TEDDLETON, RONALD DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DALE
Last Name:TEDDLETON
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 1:723 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1633
Mailing Address - Country:US
Mailing Address - Phone:618-638-5954
Mailing Address - Fax:618-524-8607
Practice Address - Street 1:723 MARKET ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-638-5954
Practice Address - Fax:618-524-8607
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012548111N00000X
TN0000951547111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor