Provider Demographics
NPI:1073919080
Name:KLINGENBERG, DEAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:SCOTT
Last Name:KLINGENBERG
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 1:1536 FORDING ISLAND RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1120
Mailing Address - Country:US
Mailing Address - Phone:616-610-7743
Mailing Address - Fax:
Practice Address - Street 1:1536 FORDING ISLAND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1120
Practice Address - Country:US
Practice Address - Phone:616-610-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor