Provider Demographics
NPI:1720197502
Name:TENOLD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:TENOLD CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-833-8777
Mailing Address - Street 1:3814 OAKWOOD HILLS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7757
Mailing Address - Country:US
Mailing Address - Phone:715-833-8777
Mailing Address - Fax:715-833-8774
Practice Address - Street 1:3814 OAKWOOD HILLS PARKWAY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7757
Practice Address - Country:US
Practice Address - Phone:715-833-8777
Practice Address - Fax:715-833-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38990900Medicaid
WI38990900Medicaid