Individual
SISSAY TEZERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
18551 W 10 MILE RD, SOUTHFIELD, MI 48075-2663
(248) 443-1995
(248) 443-5573
Mailing address
18551 W 10 MILE RD, SOUTHFIELD, MI 48075-2663
(248) 443-1995
(248) 443-5573
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
ST006145
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95OF373730
BCBS
MI
01
—
ST006145
LICENSE
MI
Enumeration date
03/22/2006
Last updated
07/08/2007
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