Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 161163-1202 | UT |
NPI | 1164559266 |
---|---|
Provider Name | Dr. Victor Louis Tebbs |
First Address | Hurricane, UT 84737-3484 |
Second Address | Hurricane, UT 84737-3484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T78034 | (02) | UT |