Provider Demographics
NPI:1407931991
Name:TEBBY, ALAN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MICHAEL
Last Name:TEBBY
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 1:8415 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
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908831Medicaid
NC7908831Medicaid
NC244512BMedicare ID - Type UnspecifiedCHIROPRACTOR