Provider Demographics
NPI:1033328257
Name:TEJCEK, JERRY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ROBERT
Last Name:TEJCEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 W. BIRCH RD.
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-8362
Mailing Address - Country:US
Mailing Address - Phone:989-821-8070
Mailing Address - Fax:989-821-8070
Practice Address - Street 1:7905 W. BIRCH RD.
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-8362
Practice Address - Country:US
Practice Address - Phone:989-821-8070
Practice Address - Fax:989-821-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor