Provider Demographics
NPI:1164559266
Name:TEBBS, VICTOR LOUIS (DC)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:LOUIS
Last Name:TEBBS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MRS
Other - First Name:LORA
Other - Middle Name:LEE
Other - Last Name:TEBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:15 N 200 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3484
Mailing Address - Country:US
Mailing Address - Phone:435-635-4688
Mailing Address - Fax:435-635-4689
Practice Address - Street 1:15 N 200 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3484
Practice Address - Country:US
Practice Address - Phone:435-635-4688
Practice Address - Fax:435-635-4689
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161163-1202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78034Medicare UPIN