Provider Demographics
NPI:1003390063
Name:TONDERUM FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TONDERUM FAMILY CHIROPRACTIC PLLC
Other - Org Name:LEGACY FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TONDERUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-209-2597
Mailing Address - Street 1:50 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1055
Mailing Address - Country:US
Mailing Address - Phone:320-774-1013
Mailing Address - Fax:
Practice Address - Street 1:171 7TH AVE S
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1362
Practice Address - Country:US
Practice Address - Phone:320-744-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty