Provider Demographics
NPI:1346231370
Name:TENJERAS, JODY (DC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:TENJERAS
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 1:10635 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2147
Mailing Address - Country:US
Mailing Address - Phone:248-698-8677
Mailing Address - Fax:348-698-8645
Practice Address - Street 1:10635 HIGHLAND ROAD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-3169
Practice Address - Country:US
Practice Address - Phone:248-698-8677
Practice Address - Fax:248-698-8645
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950F354030OtherBCBSM
950F354030OtherBCBSM
U51694Medicare UPIN