Provider Demographics
NPI:1104031749
Name:TENNEY, ROBERT WILLIAM (D C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:TENNEY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-3824
Mailing Address - Country:US
Mailing Address - Phone:207-623-3517
Mailing Address - Fax:207-623-3518
Practice Address - Street 1:503 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-3824
Practice Address - Country:US
Practice Address - Phone:207-623-3517
Practice Address - Fax:207-623-3518
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor