Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2613 | WI |
NPI | 1275641011 |
---|---|
Provider Name | Dr. Scott M Tenold |
First Address | Eau Claire, WI 54701-7757 |
Second Address | Eau Claire, WI 54701-7757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38849700 | (05) | WI |
T42209 | (02) | WI |