Provider Demographics
NPI:1992906531
Name:JODY TENJERAS, DC, PC
Entity type:Organization
Organization Name:JODY TENJERAS, DC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:TENJERAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:248-698-8677
Mailing Address - Street 1:10531 HIGHLAND RD.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3169
Mailing Address - Country:US
Mailing Address - Phone:248-698-8677
Mailing Address - Fax:
Practice Address - Street 1:10531 HIGHLAND ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-3169
Practice Address - Country:US
Practice Address - Phone:248-698-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007118111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU51694Medicare UPIN
MI0M22370Medicare ID - Type Unspecified