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Individual
DR. TERESA R TICE
Active
Individual
DR. TERESA R TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1151
LA
111N00000X
Chiropractor
Primary
1426
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133793718
—
AR
01
—
57685
GROUP #
—
Enumeration date
02/06/2006
Last updated
07/27/2010
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