Provider Demographics
NPI:1346305968
Name:TEGENKAMP, SHANE (DC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:TEGENKAMP
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 1:8880 B COLERAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251
Mailing Address - Country:US
Mailing Address - Phone:513-245-9100
Mailing Address - Fax:513-245-2696
Practice Address - Street 1:1010 OHIO PIKE STE B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2300
Practice Address - Country:US
Practice Address - Phone:513-449-1805
Practice Address - Fax:513-449-8490
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor