Provider Demographics
NPI:1083351886
Name:TESKE, DYLAN MATHEW (DC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:MATHEW
Last Name:TESKE
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 1:4380 PARKLAWN AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4633
Mailing Address - Country:US
Mailing Address - Phone:701-440-0131
Mailing Address - Fax:
Practice Address - Street 1:1820 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6810
Practice Address - Country:US
Practice Address - Phone:651-489-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor