Healthcare Provider Details

I. General information

NPI: 1275641011
Provider Name (Legal Business Name): SCOTT M TENOLD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7757
US

IV. Provider business mailing address

3814 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7757
US

V. Phone/Fax

Practice location:
  • Phone: 715-833-8777
  • Fax: 715-833-8774
Mailing address:
  • Phone: 715-833-8777
  • Fax: 715-833-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2613
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: