Provider Demographics
NPI:1982887261
Name:GLEN R TESSMAN
Entity Type:Organization
Organization Name:GLEN R TESSMAN
Other - Org Name:TESSMAN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-641-9700
Mailing Address - Street 1:306 GRANBURY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4853
Mailing Address - Country:US
Mailing Address - Phone:817-641-9700
Mailing Address - Fax:817-641-8190
Practice Address - Street 1:306 GRANBURY ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4853
Practice Address - Country:US
Practice Address - Phone:817-641-9700
Practice Address - Fax:817-641-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9660111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00073579OtherRR MEDICARE
TX606678OtherBCBS
TX660416OtherACN
TX973406OtherGALAXY HEALTH
TX606678OtherBCBS