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General NPI Number Information
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NPI Number | 1346305968
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Entity Type | Individual
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Provider Name | SHANE TEGENKAMP DC
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 1010 OHIO PIKE STE B
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City | CINCINNATI
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State | OH
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Zip | 45245-2300
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Country | US
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Telephone | 513-449-1805
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Fax | 513-449-8490
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Provider Business Mailing Address
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Address Line | 8880 B COLERAIN AVENUE
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City | CINCINNATI
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State | OH
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Zip | 45251
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Country | US
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Telephone | 513-245-9100
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Fax | 513-245-2696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2275
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License Number State | OH
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