Provider Demographics
NPI:1023295482
Name:W. RICHARD TEETERS, LLC
Entity type:Organization
Organization Name:W. RICHARD TEETERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-252-4400
Mailing Address - Street 1:1353 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3425
Mailing Address - Country:US
Mailing Address - Phone:937-252-4400
Mailing Address - Fax:937-252-4402
Practice Address - Street 1:1353 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3425
Practice Address - Country:US
Practice Address - Phone:937-252-4400
Practice Address - Fax:937-252-4402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W. RICHARD TEETERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH754261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0981988Medicaid
OH9256091Medicare PIN