Provider Demographics
NPI:1962834606
Name:KEDWARDS, TERESA J (DC)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:KEDWARDS
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 1:4050 KATELLA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3466
Mailing Address - Country:US
Mailing Address - Phone:562-430-4451
Mailing Address - Fax:
Practice Address - Street 1:4050 KATELLA AVE STE 107
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3466
Practice Address - Country:US
Practice Address - Phone:562-430-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor