Provider Demographics
NPI:1700681756
Name:TEETERS, STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:TEETERS
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 1:153 GLENEAGLE GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-3044
Mailing Address - Country:US
Mailing Address - Phone:814-599-7347
Mailing Address - Fax:
Practice Address - Street 1:6320 SAINT AUGUSTINE RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2813
Practice Address - Country:US
Practice Address - Phone:904-320-0807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor