Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIRO08979 | GA |
NPI | 1295093540 |
---|---|
Provider Name | Dr. David Ryan Tener |
First Address | Marietta, GA 30067-6912 |
Second Address | Kennesaw, GA 30144-1346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 24/04/2012 |