Healthcare Provider Details

I. General information

NPI: 1174870166
Provider Name (Legal Business Name): CEDAR ISLAND CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 207
NEW HOPE MN
55427-1240
US

IV. Provider business mailing address

4124 QUEBEC AVE N STE 207
NEW HOPE MN
55427-1240
US

V. Phone/Fax

Practice location:
  • Phone: 763-205-5733
  • Fax: 763-205-2785
Mailing address:
  • Phone: 763-205-5733
  • Fax: 763-205-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2018
License Number StateMN

VIII. Authorized Official

Name: DR. LORI TENENBAUM
Title or Position: PRESIDENT
Credential: DC
Phone: 763-205-5733