Provider Demographics
NPI:1013926575
Name:TEBBE, REJINA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:REJINA
Middle Name:LOUISE
Last Name:TEBBE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:REJINA
Other - Middle Name:LOUISE
Other - Last Name:DIEKEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14015 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3647
Mailing Address - Country:US
Mailing Address - Phone:618-526-7732
Mailing Address - Fax:618-526-8312
Practice Address - Street 1:14015 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3647
Practice Address - Country:US
Practice Address - Phone:618-526-7732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK44275Medicare PIN