Provider Demographics
NPI:1649344433
Name:CARAWAY, THERESE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:MARIE
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:THERESE
Other - Middle Name:MARIE
Other - Last Name:DOUNIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:36 MALAGA COVE PLAZA
Mailing Address - Street 2:#202
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:310-375-6701
Mailing Address - Fax:
Practice Address - Street 1:36 MALAGA COVE PLAZA
Practice Address - Street 2:#202
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274
Practice Address - Country:US
Practice Address - Phone:310-375-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21671111N00000X
CA21671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor