MEDICARE: JODY TENJERAS DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301007118	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950F354030	OTHER		BCBSM

General Provider Information

NPI Number	:	1346231370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY TENJERAS DC

Provider Business Mailing Address
First Line	:	10635 HIGHLAND RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2147
Country	:	US
Telephone Number	:	248-698-8677
Fax Number	:	348-698-8645

Provider Business Practice Location Address
First Line	:	10635 HIGHLAND ROAD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-3169
Country	:	US
Telephone Number	:	248-698-8677
Fax Number	:	248-698-8645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	09/03/2013

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