Provider Demographics
NPI:1730299223
Name:JOEBGEN, TALLEREE NICHOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:TALLEREE
Middle Name:NICHOLE
Last Name:JOEBGEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2654
Mailing Address - Country:US
Mailing Address - Phone:703-757-5817
Mailing Address - Fax:703-757-5478
Practice Address - Street 1:754 WALKER RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2654
Practice Address - Country:US
Practice Address - Phone:703-757-5817
Practice Address - Fax:703-757-5478
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA167445OtherBLUECROSS BLUE SHIELD
VA167445OtherBLUECROSS BLUE SHIELD
VA490012Medicare PIN