Provider Demographics
NPI:1033324876
Name:TRAVIS J. TESSENDORF DC.PC
Entity Type:Organization
Organization Name:TRAVIS J. TESSENDORF DC.PC
Other - Org Name:TESSENDORF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TESSENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-564-0193
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-0727
Mailing Address - Country:US
Mailing Address - Phone:402-564-0193
Mailing Address - Fax:402-564-9508
Practice Address - Street 1:4315 23RD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-8507
Practice Address - Country:US
Practice Address - Phone:402-564-0193
Practice Address - Fax:402-564-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty