Provider Demographics
NPI:1447439849
Name:TESKE FAMILY CHIROPRACTIC CENTER LTD
Entity type:Organization
Organization Name:TESKE FAMILY CHIROPRACTIC CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TESKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-258-3965
Mailing Address - Street 1:425 S GOVERNORS HWY
Mailing Address - Street 2:PO BOX 848
Mailing Address - City:PEOTONE
Mailing Address - State:IL
Mailing Address - Zip Code:60468-9116
Mailing Address - Country:US
Mailing Address - Phone:708-258-3965
Mailing Address - Fax:708-258-6640
Practice Address - Street 1:425 S GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468-9116
Practice Address - Country:US
Practice Address - Phone:708-258-3965
Practice Address - Fax:708-258-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617033261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9919487OtherBLUE CROSS BLUE SHIELD
IL350046509OtherRR MEDICARE
ILU48683Medicare UPIN
IL555130Medicare PIN