Provider Demographics
NPI:1912923244
Name:TEUSAW, DONALD RICHARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:RICHARD
Last Name:TEUSAW
Suffix:JR
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 1:11525 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1207
Mailing Address - Country:US
Mailing Address - Phone:402-292-1337
Mailing Address - Fax:402-292-1369
Practice Address - Street 1:11525 S 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1207
Practice Address - Country:US
Practice Address - Phone:402-292-1337
Practice Address - Fax:402-292-1369
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080433700Medicaid
NE36625OtherBLUE CROSS BLUE SHIELD ID
NE36625OtherBLUE CROSS BLUE SHIELD ID
NET71367Medicare UPIN