Provider Demographics
NPI:1770695553
Name:TELLER, TODD MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:TELLER
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:PO BOX 1697
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1837
Mailing Address - Country:US
Mailing Address - Phone:480-633-3151
Mailing Address - Fax:480-383-6076
Practice Address - Street 1:235 E WARNER RD
Practice Address - Street 2:STE B104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2972
Practice Address - Country:US
Practice Address - Phone:480-633-3151
Practice Address - Fax:480-383-6076
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 005311111N00000X
AZ8136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor