Provider Demographics
NPI:1720064520
Name:TENDER CHIROPRACTIC HEALTH CENTER PA
Entity Type:Organization
Organization Name:TENDER CHIROPRACTIC HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-247-0058
Mailing Address - Street 1:219 NORTH 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-247-0058
Mailing Address - Fax:904-242-9779
Practice Address - Street 1:219 NORTH 11TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-247-0058
Practice Address - Fax:904-242-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280005500Medicaid
U91723Medicare UPIN
70207Medicare ID - Type Unspecified