Provider Demographics
NPI:1396964573
Name:TEDESCHI, KAREN L (DC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:TEDESCHI
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 1:1770 CENTURY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3395
Mailing Address - Country:US
Mailing Address - Phone:404-320-0204
Mailing Address - Fax:404-320-1417
Practice Address - Street 1:1770 CENTURY BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3395
Practice Address - Country:US
Practice Address - Phone:404-320-0204
Practice Address - Fax:404-320-1417
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor