Provider Demographics
NPI:1912268327
Name:TENNANT CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TENNANT CHIROPRACTIC PLLC
Other - Org Name:WELLNESS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:TENNANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-864-7480
Mailing Address - Street 1:853 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NUCLA
Mailing Address - State:CO
Mailing Address - Zip Code:81424
Mailing Address - Country:US
Mailing Address - Phone:970-864-7480
Mailing Address - Fax:541-808-2016
Practice Address - Street 1:853 MAIN ST
Practice Address - Street 2:
Practice Address - City:NUCLA
Practice Address - State:CO
Practice Address - Zip Code:81424
Practice Address - Country:US
Practice Address - Phone:970-864-7480
Practice Address - Fax:514-808-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3090111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty