Provider Demographics
NPI:1033261763
Name:DENIS, BERNARD JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:JOHN
Last Name:DENIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 STATE ROUTE 981
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2687
Mailing Address - Country:US
Mailing Address - Phone:724-539-4074
Mailing Address - Fax:724-539-4075
Practice Address - Street 1:5927 STATE ROUTE 981
Practice Address - Street 2:SUITE 2
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2687
Practice Address - Country:US
Practice Address - Phone:724-539-4074
Practice Address - Fax:724-539-4075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005133L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA803913Medicare ID - Type Unspecified