Provider Demographics
NPI:1265533418
Name:TEEL, JULIE SUZANNE (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:SUZANNE
Last Name:TEEL
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 1:509 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1328
Mailing Address - Country:US
Mailing Address - Phone:618-439-7171
Mailing Address - Fax:618-439-6151
Practice Address - Street 1:509 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1328
Practice Address - Country:US
Practice Address - Phone:618-439-7171
Practice Address - Fax:618-439-6151
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038009609Medicaid
IL2832008OtherBLUE CROSS BLUE SHIELD
626640OtherHEALTHLINK
226906OtherGHP
IL038009609Medicaid
IL206899Medicare PIN