Provider Demographics
NPI:1407211576
Name:DENNIS, ANNALIESE (DC)
Entity Type:Individual
Prefix:
First Name:ANNALIESE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503B ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2326
Mailing Address - Country:US
Mailing Address - Phone:941-769-4380
Mailing Address - Fax:
Practice Address - Street 1:1360 S PATRICK DR
Practice Address - Street 2:SUITE 7
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4316
Practice Address - Country:US
Practice Address - Phone:941-769-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor