Provider Demographics
NPI:1861574089
Name:FEBBO, THERESA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:FEBBO
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 1:4901 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4634
Mailing Address - Country:US
Mailing Address - Phone:816-665-8838
Mailing Address - Fax:816-584-0149
Practice Address - Street 1:6908 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1764
Practice Address - Country:US
Practice Address - Phone:816-665-8838
Practice Address - Fax:816-584-0149
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16971084OtherBC/BS
MO10001164303OtherCOMMUNITY HEALTH PLAN
MO0002689AMedicare ID - Type Unspecified