Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | A06012 | IA |
NPI | 1265515076 |
---|---|
Provider Name | Dr. Steven Robert Tenold |
First Address | Belmond, IA 50421 |
Second Address | Belmond, IA 50421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59942 | BCBS PROVIDER NUMBER (01) | IA |
U66340 | (02) | IA |