Provider Demographics
NPI:1093816365
Name:DENT, STEPHEN E (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:DENT
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 1:1202 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-1942
Mailing Address - Country:US
Mailing Address - Phone:620-285-6909
Mailing Address - Fax:620-285-6909
Practice Address - Street 1:1202 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-1942
Practice Address - Country:US
Practice Address - Phone:620-285-6909
Practice Address - Fax:620-285-6909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS481155584OtherFEDERAL TAX I.D. NUMBER
KS23577OtherBLUE CROSS PROVIDER