Provider Demographics
NPI:1356658553
Name:JOHN A DENNEHY JR DC PC
Entity Type:Organization
Organization Name:JOHN A DENNEHY JR DC PC
Other - Org Name:NORTHPORT CHIROPRACTIC CENTRE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNEHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:573-221-2001
Mailing Address - Street 1:15 NORTHPORT PLZ
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2269
Mailing Address - Country:US
Mailing Address - Phone:573-221-2001
Mailing Address - Fax:573-221-3316
Practice Address - Street 1:15 NORTHPORT PLZ
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2269
Practice Address - Country:US
Practice Address - Phone:573-221-2001
Practice Address - Fax:573-221-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1740390871OtherNPI
MO5580OtherANTHEM