Provider Demographics
NPI:1396874848
Name:TEBO, MICHAEL ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLAN
Last Name:TEBO
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 1:1970 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6005
Mailing Address - Country:US
Mailing Address - Phone:310-543-9001
Mailing Address - Fax:
Practice Address - Street 1:1970 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6005
Practice Address - Country:US
Practice Address - Phone:310-543-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor