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Individual

DR. TRAVIS J TESSENDORF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
2360 26TH AVE, COLUMBUS, NE 68601-2527
(402) 564-0193
(402) 564-0179
Mailing address
PO BOX 727, COLUMBUS, NE 68602-0727
(402) 564-0193
(402) 564-0179

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1197
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
09641
BLUE CROSS BLUE SHIELD
NE
01
15979
MIDLANDS CHOICE PPO
NE
01
350049151
RAILROAD MEDICARE
01
470821974
FEDERAL TAX ID
NE
05
47082197400
NE
Enumeration date
08/22/2005
Last updated
01/31/2014
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