Provider Demographics
NPI:1235395237
Name:DONALD R TEUSAW DC PC
Entity Type:Organization
Organization Name:DONALD R TEUSAW DC PC
Other - Org Name:TEUSAW CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEUSAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-292-1337
Mailing Address - Street 1:11525 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1207
Mailing Address - Country:US
Mailing Address - Phone:402-292-1337
Mailing Address - Fax:402-292-1369
Practice Address - Street 1:11525 S 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1207
Practice Address - Country:US
Practice Address - Phone:402-292-1337
Practice Address - Fax:402-292-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE350045550OtherUNION PACIFIC MEDICARE
NE36625OtherBLUE CROSS BLUE SHIELD
NE1912923244OtherINDIVIDUAL NPI
NE350045550OtherUNION PACIFIC MEDICARE