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General NPI Number Information
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NPI Number | 1982887261
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Entity Type | Organization
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Legal Business Name | GLEN R TESSMAN
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 306 GRANBURY ST SUITE B
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City | CLEBURNE
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State | TX
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Zip | 76033-4853
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Country | US
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Telephone | 817-641-9700
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Fax | 817-641-8190
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Provider Business Mailing Address
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Address Line | 306 GRANBURY ST SUITE B
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City | CLEBURNE
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State | TX
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Zip | 76033-4853
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Country | US
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Telephone | 817-641-9700
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Fax | 817-641-8190
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | GLEN R TESSMAN
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Credential | DC
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Telephone | 817-641-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 9660
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License Number State | TX
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