Organization Name: | MELICIEN TETTAMBEL, D.O., S.C. |
NPI Number: | 1912028861 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELICIEN TETTAMBEL (PHYSICIAN) |
Mailing Address: | 1108 E Patterson St Suite 3 Kirksville |
State: | MO US |
Postal Code: | 635014002 |
Phone Number: | 6606275175 |
Fax Number: | 6606275180 |
NPI Enumeration Date: | 04/02/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | R9714 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |