Provider Demographics
NPI:1982816245
Name:TENENBAUM, LORI R (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:R
Last Name:TENENBAUM
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 1:4124 QUEBEC AVE N STE 207
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1240
Mailing Address - Country:US
Mailing Address - Phone:763-205-5733
Mailing Address - Fax:763-205-2785
Practice Address - Street 1:4124 QUEBEC AVE N STE 207
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1240
Practice Address - Country:US
Practice Address - Phone:763-205-5733
Practice Address - Fax:763-205-2785
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1BO81ROOtherBLUE CROSS
MN350000414Medicare ID - Type Unspecified