Provider Demographics
NPI:1457300220
Name:HOMACK, DENNIS MJ (DC, MS, CCSP)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MJ
Last Name:HOMACK
Suffix:
Gender:M
Credentials:DC, MS, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 VAN RENSSALAER ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-1705
Mailing Address - Country:US
Mailing Address - Phone:315-568-8680
Mailing Address - Fax:
Practice Address - Street 1:2360 STATE ROUTE 89
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-9425
Practice Address - Country:US
Practice Address - Phone:315-568-3157
Practice Address - Fax:315-568-3017
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX08680-2111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC-08680-2OtherWORKERS COMP
NY11122804OtherCAQH UNIVERSAL CREDENTIAL
NY11122804OtherCAQH UNIVERSAL CREDENTIAL