MEDICARE: DR. BRENDA SUE TESKE D.C.

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	038-007458	IL

General Provider Information

NPI Number	:	1952401572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA SUE TESKE D.C.

Provider Business Mailing Address
First Line	:	425 S GOVERNORS HWY
Second Line	:
City	:	PEOTONE
State	:	IL
Zip	:	60468-9116
Country	:	US
Telephone Number	:	708-258-3965
Fax Number	:	708-258-6640

Provider Business Practice Location Address
First Line	:	425 S GOVERNORS HWY
Second Line	:
City	:	PEOTONE
State	:	IL
Zip	:	60468-9116
Country	:	US
Telephone Number	:	708-258-3965
Fax Number	:	708-258-6640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	01/19/2016

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