Healthcare Provider Details

I. General information

NPI: 1891302808
Provider Name (Legal Business Name): TRENTON FAMILY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E STATE ST
TRENTON OH
45067-1530
US

IV. Provider business mailing address

4222 COTTON RUN RD
HAMILTON OH
45011-9657
US

V. Phone/Fax

Practice location:
  • Phone: 513-468-0061
  • Fax:
Mailing address:
  • Phone: 513-594-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE L TEGENKAMP
Title or Position: OWNER
Credential: DC
Phone: 513-594-1431