Provider Demographics
NPI:1770817934
Name:TINNEN FAMILY CHIROPRACTIC, S.C.
Entity type:Organization
Organization Name:TINNEN FAMILY CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-441-1181
Mailing Address - Street 1:1234 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3755
Mailing Address - Country:US
Mailing Address - Phone:608-441-1181
Mailing Address - Fax:
Practice Address - Street 1:1234 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3755
Practice Address - Country:US
Practice Address - Phone:608-441-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4516-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty