Provider Demographics
NPI:1164869855
Name:TELLEFSON, SCOTT ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:TELLEFSON
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 1:635 MEADOW TRCE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53531-9679
Mailing Address - Country:US
Mailing Address - Phone:608-290-7293
Mailing Address - Fax:
Practice Address - Street 1:635 MEADOW TRCE
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:WI
Practice Address - Zip Code:53531-9679
Practice Address - Country:US
Practice Address - Phone:608-290-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4927-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor