Healthcare Provider Details

I. General information

NPI: 1982816245
Provider Name (Legal Business Name): LORI R TENENBAUM DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 02/27/2012
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:
Title or Position:
Credential:
Phone: