Provider Demographics
NPI:1912335860
Name:CLINTON BACK AND NECK FAMILY WELLNESS, PC
Entity Type:Organization
Organization Name:CLINTON BACK AND NECK FAMILY WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:TENNANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-242-5375
Mailing Address - Street 1:951 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5032
Mailing Address - Country:US
Mailing Address - Phone:563-242-5375
Mailing Address - Fax:563-243-5375
Practice Address - Street 1:951 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5032
Practice Address - Country:US
Practice Address - Phone:563-242-5375
Practice Address - Fax:563-243-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty