Provider Demographics
NPI:1114287489
Name:TENNANT, MICHAEL D (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:TENNANT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NUCLA
Mailing Address - State:CO
Mailing Address - Zip Code:81424-0454
Mailing Address - Country:US
Mailing Address - Phone:970-864-7480
Mailing Address - Fax:541-808-2016
Practice Address - Street 1:853 MAIN ST
Practice Address - Street 2:
Practice Address - City:NUCLA
Practice Address - State:CO
Practice Address - Zip Code:81424-0454
Practice Address - Country:US
Practice Address - Phone:970-864-7480
Practice Address - Fax:541-808-2016
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3090111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner