Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 4367 | MN |
Y | 111NX0100X | Occupational Health | 4367 | MN |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 4367 | MN |
NPI | 1982743241 |
---|---|
Provider Name | Dr. Eric Leigh Tessmer |
First Address | Lakeville, MN 55044-6011 |
Second Address | Lakeville, MN 55044-6011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 30/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056G6IN | BLUE CROSS BLUE SHIELD (01) | MN |
U95547 | (02) | MN |