Provider Demographics
NPI:1417233461
Name:DENNIS, RICHARD TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TYLER
Last Name:DENNIS
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:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-0393
Mailing Address - Country:US
Mailing Address - Phone:808-391-4064
Mailing Address - Fax:
Practice Address - Street 1:54-063 HAUULA HOMESTEAD RD
Practice Address - Street 2:UNIT C
Practice Address - City:HAUULA
Practice Address - State:HI
Practice Address - Zip Code:96717-9641
Practice Address - Country:US
Practice Address - Phone:808-391-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC1215111N00000X, 111NP0017X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician