Provider Demographics
NPI:1043211485
Name:DENTON, BRUCE E (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:DENTON
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 1:4167 E. HITT STREET
Mailing Address - Street 2:
Mailing Address - City:MT. MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:61054
Mailing Address - Country:US
Mailing Address - Phone:815-734-7347
Mailing Address - Fax:815-734-6230
Practice Address - Street 1:4167 E. HITT STREET
Practice Address - Street 2:
Practice Address - City:MT. MORRIS
Practice Address - State:IL
Practice Address - Zip Code:61054
Practice Address - Country:US
Practice Address - Phone:815-734-7347
Practice Address - Fax:815-734-6230
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU80354Medicare UPIN
IL583530Medicare ID - Type Unspecified