Provider Demographics
NPI:1770648958
Name:TENNENBAUM, DAN (LAC,OMD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:TENNENBAUM
Suffix:
Gender:M
Credentials:LAC,OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14810 LAKE HILLS BLVD # A-2
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5821
Mailing Address - Country:US
Mailing Address - Phone:425-373-1416
Mailing Address - Fax:425-373-1416
Practice Address - Street 1:14810 LAKE HILLS BLVD # A-2
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5821
Practice Address - Country:US
Practice Address - Phone:425-373-1416
Practice Address - Fax:425-373-1416
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 203171100000X
CACE 2559171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist