Provider Demographics
NPI:1598714024
Name:TENNEY, TAD N (DC)
Entity Type:Individual
Prefix:
First Name:TAD
Middle Name:N
Last Name:TENNEY
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 1:806 BUCHANAN BLVD # 109
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2130
Mailing Address - Country:US
Mailing Address - Phone:702-293-0041
Mailing Address - Fax:702-293-2834
Practice Address - Street 1:806 BUCHANAN BLVD #109
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2130
Practice Address - Country:US
Practice Address - Phone:702-293-0041
Practice Address - Fax:702-293-2834
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU75740Medicare UPIN
NV39142Medicare ID - Type Unspecified