Healthcare Provider Details

I. General information

NPI: 1366346629
Provider Name (Legal Business Name): MARK THOMAS TEGTMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST
CROWN POINT IN
46307-4069
US

IV. Provider business mailing address

910 JACKSON PL
DYER IN
46311-1111
US

V. Phone/Fax

Practice location:
  • Phone: 219-741-3217
  • Fax:
Mailing address:
  • Phone: 219-741-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05488
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: