Individual
DR. THOMAS N TESSENDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1401 W BIZTOWN LOOP, HAYDEN, ID 83835-5113
(208) 762-3660
(208) 762-3600
Mailing address
1401 W BIZTOWN LOOP, HAYDEN, ID 83835-5113
(208) 762-3660
(208) 762-3600
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2047
WI
111N00000X
Chiropractor
Primary
CHIA-1564
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000075015
MEDICARE PTAN
—
Enumeration date
08/09/2005
Last updated
11/26/2013
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