Provider Demographics
NPI:1346373230
Name:TEBBE, ABIGAIL CALLISTA (DC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CALLISTA
Last Name:TEBBE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4855 ASBURY RD
Practice Address - Street 2:STE. 6
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-0483
Practice Address - Country:US
Practice Address - Phone:563-556-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06957111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor