Healthcare Provider Details

I. General information

NPI: 1427040724
Provider Name (Legal Business Name): TRAVIS J TESSENDORF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

2360 26TH AVE
COLUMBUS NE
68601-2527
US

IV. Provider business mailing address

PO BOX 727
COLUMBUS NE
68602-0727
US

V. Phone/Fax

Practice location:
  • Phone: 402-564-0193
  • Fax: 402-564-0179
Mailing address:
  • Phone: 402-564-0193
  • Fax: 402-564-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1197
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: