Provider Demographics
NPI:1104919596
Name:TROTTER, TENA LEE (DC)
Entity type:Individual
Prefix:DR
First Name:TENA
Middle Name:LEE
Last Name:TROTTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N JEFF DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1665
Mailing Address - Country:US
Mailing Address - Phone:678-206-1729
Mailing Address - Fax:
Practice Address - Street 1:560 N JEFF DAVIS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1665
Practice Address - Country:US
Practice Address - Phone:770-719-8785
Practice Address - Fax:770-719-8715
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3619111N00000X
GACHIR008525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244302202Medicare ID - Type Unspecified