Provider Demographics
NPI:1780128777
Name:TEACHOUT CHIROPRACTIC & WELLNESS CENTER PA
Entity type:Organization
Organization Name:TEACHOUT CHIROPRACTIC & WELLNESS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEACHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-466-5656
Mailing Address - Street 1:16521 SAN CARLOS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5245
Mailing Address - Country:US
Mailing Address - Phone:239-466-5656
Mailing Address - Fax:239-466-1102
Practice Address - Street 1:16521 SAN CARLOS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5245
Practice Address - Country:US
Practice Address - Phone:239-466-5656
Practice Address - Fax:239-466-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 12025111N00000X
363L00000X, 111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRWAIEOtherFLORIDA BLUE
4ZZ2MOtherFLORIDA BLUE
FLRWAIEOtherFLORIDA BLUE