Provider Demographics
NPI:1265568067
Name:TESAR, TERRY DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DEAN
Last Name:TESAR
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 1:111 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1725
Mailing Address - Country:US
Mailing Address - Phone:563-886-6656
Mailing Address - Fax:563-886-6656
Practice Address - Street 1:111 W 4TH ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1725
Practice Address - Country:US
Practice Address - Phone:563-886-6656
Practice Address - Fax:563-886-6656
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor