Provider Demographics
NPI:1366645038
Name:TWEEDIE, JOHN TELFER III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TELFER
Last Name:TWEEDIE
Suffix:III
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 1:201 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1519
Mailing Address - Country:US
Mailing Address - Phone:417-777-4848
Mailing Address - Fax:417-777-3066
Practice Address - Street 1:201 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1519
Practice Address - Country:US
Practice Address - Phone:417-777-4848
Practice Address - Fax:417-777-3066
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166831111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014855Medicare ID - Type Unspecified
MO319264855Medicare UPIN