Provider Demographics
NPI:1497241095
Name:TEGELS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:TEGELS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:TEGELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-831-2460
Mailing Address - Street 1:601 FOURTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1652
Mailing Address - Country:US
Mailing Address - Phone:507-831-2460
Mailing Address - Fax:507-831-2164
Practice Address - Street 1:601 FOURTH AVENUE
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1652
Practice Address - Country:US
Practice Address - Phone:507-831-2460
Practice Address - Fax:507-831-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN147827300Medicaid