Provider Demographics
NPI:1730600131
Name:TEACHWORTH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:TEACHWORTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEACHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-875-3010
Mailing Address - Street 1:1435 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1021
Mailing Address - Country:US
Mailing Address - Phone:785-875-3010
Mailing Address - Fax:785-875-4746
Practice Address - Street 1:3056 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-5001
Practice Address - Country:US
Practice Address - Phone:785-875-3010
Practice Address - Fax:785-875-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04366261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center