Provider Demographics
NPI:1457683245
Name:DENAIS, BAMBI R (DC)
Entity Type:Individual
Prefix:DR
First Name:BAMBI
Middle Name:R
Last Name:DENAIS
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 1:4400 E HIGHWAY 20 STE 207
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7700
Mailing Address - Country:US
Mailing Address - Phone:850-897-1177
Mailing Address - Fax:850-897-1377
Practice Address - Street 1:4400 E HIGHWAY 20 STE 207
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-7700
Practice Address - Country:US
Practice Address - Phone:850-897-1177
Practice Address - Fax:850-897-1377
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1545111N00000X
FL12307111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111N00000XChiropractic ProvidersChiropractor