Provider Demographics
NPI:1346227279
Name:CAUDILL, DENNIS CLAY (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:CLAY
Last Name:CAUDILL
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 1:2406 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6910
Mailing Address - Country:US
Mailing Address - Phone:704-932-0801
Mailing Address - Fax:704-934-0070
Practice Address - Street 1:2406 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6910
Practice Address - Country:US
Practice Address - Phone:704-932-0801
Practice Address - Fax:704-934-0070
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908296Medicaid
NCT64334Medicare UPIN
NC8908296Medicaid