Provider Demographics
NPI:1982743241
Name:TESSMER, ERIC LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEIGH
Last Name:TESSMER
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 1:11276 210TH ST W STE 109
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6011
Mailing Address - Country:US
Mailing Address - Phone:952-469-3443
Mailing Address - Fax:952-469-3473
Practice Address - Street 1:11276 210TH W ST 109
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6011
Practice Address - Country:US
Practice Address - Phone:952-469-3443
Practice Address - Fax:952-469-3473
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4367111NN1001X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN056G6INOtherBLUE CROSS BLUE SHIELD
MN056G6INOtherBLUE CROSS BLUE SHIELD
MN350003155Medicare ID - Type Unspecified