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General NPI Number Information
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NPI Number | 1245776301
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Entity Type | Organization
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Legal Business Name | KRISTEN M TENWOLDE
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 1764 SAN DIEGO AVENUE # 140
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City | SAN DIEGO
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State | CA
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Zip | 92110
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Country | US
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Telephone | 619-543-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 16809 DAZA DRIVE
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City | RAMONA
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State | CA
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Zip | 92065
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Country | US
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Telephone | 760-271-4256
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | KRISTEN M TENWOLDE
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Credential | D.C
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Telephone | 760-271-4256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC 33763
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License Number State | CA
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