=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912727454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TENNEH JALLOH-ADENEGAN DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2024
-----------------------------------------------------
Last Update Date | 10/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10415 W GRAND PKWY S UNIT 120
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77407-8718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-816-3771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4130 FM 762 RD STE 300
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77469-6436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-771-0659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 16149
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------