Provider Demographics
NPI:1952401572
Name:TESKE, BRENDA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SUE
Last Name:TESKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:PEOTONE
Mailing Address - State:IL
Mailing Address - Zip Code:60468-9116
Mailing Address - Country:US
Mailing Address - Phone:708-258-3965
Mailing Address - Fax:708-258-6640
Practice Address - Street 1:425 S GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468-9116
Practice Address - Country:US
Practice Address - Phone:708-258-3965
Practice Address - Fax:708-258-6640
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350046509OtherRAILROAD MEDICARE NO.
ILU48683Medicare UPIN
IL1867085OtherFIRST HEALTH PROVIDER NO.
IL555130Medicare ID - Type Unspecified
IL9919487OtherBLUE CROSS ID NUMBER