MEDICARE: TEBBY CLINIC OF CHIROPRACTIC PA

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	1548 & 1524	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275618779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEBBY CLINIC OF CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	8415 PINEVILLE MATTHEWS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4704
Country	:	US
Telephone Number	:	704-541-7111
Fax Number	:	704-541-0983

Provider Business Practice Location Address
First Line	:	8415 PINEVILLE MATTHEWS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4704
Country	:	US
Telephone Number	:	704-541-7111
Fax Number	:	704-541-0983

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALAN MICHAEL TEBBY
Credential	:	D.C.
Telephone Number	:	704-541-7111

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/15/2016

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Practice Location Address:

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Practice Fax:

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Practice Location Address:

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