Provider Demographics
NPI:1144237058
Name:TRESSEL, PAMELA JOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOAN
Last Name:TRESSEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 AVENUE OF THE CITIES STE 205
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4453
Mailing Address - Country:US
Mailing Address - Phone:309-797-6200
Mailing Address - Fax:309-797-6201
Practice Address - Street 1:3637 AVENUE OF THE CITIES STE 205
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4453
Practice Address - Country:US
Practice Address - Phone:309-797-6200
Practice Address - Fax:309-797-6201
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL94582Medicare ID - Type Unspecified
ILU92567Medicare UPIN