Provider Demographics
NPI:1669725396
Name:TVEDTEN, TRAEGER NELSON (DC)
Entity type:Individual
Prefix:DR
First Name:TRAEGER
Middle Name:NELSON
Last Name:TVEDTEN
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 1:5172 CR 2250
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337
Mailing Address - Country:US
Mailing Address - Phone:517-795-5641
Mailing Address - Fax:
Practice Address - Street 1:411 1/2 WEST 11TH STREET
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337
Practice Address - Country:US
Practice Address - Phone:620-688-6159
Practice Address - Fax:620-688-6159
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor