Provider Demographics
NPI:1972868388
Name:TEBBS CHIROPRACTIC PC
Entity type:Organization
Organization Name:TEBBS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:TEBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-635-4688
Mailing Address - Street 1:15 N 200 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3484
Mailing Address - Country:US
Mailing Address - Phone:435-635-4688
Mailing Address - Fax:435-635-4689
Practice Address - Street 1:15 N 200 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3484
Practice Address - Country:US
Practice Address - Phone:435-635-4688
Practice Address - Fax:435-635-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1611631202111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT70034Medicare UPIN