Provider Demographics
NPI:1427040724
Name:TESSENDORF, TRAVIS J (DC)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:J
Last Name:TESSENDORF
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:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-0727
Mailing Address - Country:US
Mailing Address - Phone:402-564-0193
Mailing Address - Fax:402-564-0179
Practice Address - Street 1:2360 26TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2527
Practice Address - Country:US
Practice Address - Phone:402-564-0193
Practice Address - Fax:402-564-0179
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2014-01-31
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
NE1197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09641OtherBLUE CROSS BLUE SHIELD
NE15979OtherMIDLANDS CHOICE PPO
NE47082197400Medicaid
NE470821974OtherFEDERAL TAX ID
350049151OtherRAILROAD MEDICARE
350049151OtherRAILROAD MEDICARE
NEU71132Medicare UPIN