Provider Demographics
NPI:1629067129
Name:TEGELS, THOMAS LEO (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEO
Last Name:TEGELS
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 1:601 4TH AVE
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 4TH AVE
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN147827300Medicaid
MN147827300Medicaid
U28567Medicare UPIN