Provider Demographics
NPI:1457374449
Name:TEAGUE, LOREN D (DC)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:D
Last Name:TEAGUE
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 1:574 MANZANITA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1369
Mailing Address - Country:US
Mailing Address - Phone:530-520-2052
Mailing Address - Fax:
Practice Address - Street 1:574 MANZANITA AVE STE 10
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1369
Practice Address - Country:US
Practice Address - Phone:530-520-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC029296Medicare ID - Type Unspecified