Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 714 | MS |
NPI | 1003904244 |
---|---|
Provider Name | Dr. Steve Tencer |
First Address | Southaven, MS 38671-9522 |
Second Address | Horn Lake, MS 38637-1919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |