Provider Demographics
NPI:1275618779
Name:TEBBY CLINIC OF CHIROPRACTIC PA
Entity Type:Organization
Organization Name:TEBBY CLINIC OF CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TEBBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-541-7111
Mailing Address - Street 1:8415 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4704
Mailing Address - Country:US
Mailing Address - Phone:704-541-7111
Mailing Address - Fax:704-541-0983
Practice Address - Street 1:8415 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4704
Practice Address - Country:US
Practice Address - Phone:704-541-7111
Practice Address - Fax:704-541-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1548 & 1524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908831Medicaid
NC244480CMedicare ID - Type UnspecifiedCHIROPRACTOR
NCT64503Medicare UPIN
NCT64527Medicare UPIN
NC244512BMedicare ID - Type UnspecifiedCHIROPRACTOR