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NPI Code Detail

MEDICARE: TRAVIS J TESSENDORF D.C. P.C.

MEDICARE: TRAVIS J TESSENDORF D.C. P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor1197NE

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1350049151OTHERRAILROAD MEDICARE

General Provider Information

NPI Number : 1740316793
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRAVIS J TESSENDORF D.C. P.C.
Provider Business Mailing Address
First Line : PO BOX 727
Second Line :
City : COLUMBUS
State : NE
Zip : 68602-0727
Country : US
Telephone Number : 402-564-0193
Fax Number : 402-564-0179
Provider Business Practice Location Address
First Line : 2360 26TH AVE
Second Line :
City : COLUMBUS
State : NE
Zip : 68601-2527
Country : US
Telephone Number : 402-564-0193
Fax Number : 402-564-0179
Authorized Official
Title or Position : PRESIDENT
Name : DR. TRAVIS J TESSENDORF
Credential : D.C.
Telephone Number : 402-564-0193
Provider Enumeration Date : 02/26/2007
Last Update Date : 02/09/2012

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