MEDICARE: TRAVIS J. TESSENDORF DC.PC

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
1	111N00000X	Chiropractor	1197	NE

General Provider Information

NPI Number	:	1033324876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVIS J. TESSENDORF DC.PC

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	:	402-564-9508

Provider Business Practice Location Address
First Line	:	4315 23RD ST
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-8507
Country	:	US
Telephone Number	:	402-564-0193
Fax Number	:	402-564-9508

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TRAVIS J TESSENDORF
Credential	:	D.C.
Telephone Number	:	402-564-0193

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/02/2007

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