Healthcare Provider Details

I. General information

NPI: 1295093540
Provider Name (Legal Business Name): DAVID RYAN TENER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WOOTEN LAKE RD NW STE 103
KENNESAW GA
30144-1346
US

IV. Provider business mailing address

1817 ASHBOROUGH CIR SE APT H
MARIETTA GA
30067-6912
US

V. Phone/Fax

Practice location:
  • Phone: 770-974-7470
  • Fax:
Mailing address:
  • Phone: 516-695-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIRO08979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: