Provider Demographics
NPI:1114000692
Name:POOLE, DENNIS L (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:POOLE
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 1:1289 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1910
Mailing Address - Country:US
Mailing Address - Phone:714-282-6141
Mailing Address - Fax:714-282-0513
Practice Address - Street 1:1289 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1910
Practice Address - Country:US
Practice Address - Phone:714-282-6141
Practice Address - Fax:714-282-0513
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC11019Medicare ID - Type Unspecified