Healthcare Provider Details

I. General information

NPI: 1295750131
Provider Name (Legal Business Name): ERIC JON TESSEREAU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 GODDARD AVE.
IGNACIO CO
81137-1494
US

IV. Provider business mailing address

PO BOX 1494 430 GODDARD AVENUE
IGNACIO CO
81137-1494
US

V. Phone/Fax

Practice location:
  • Phone: 970-563-0330
  • Fax: 970-563-0331
Mailing address:
  • Phone: 970-563-0330
  • Fax: 970-563-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5566
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: