Provider Demographics
NPI:1467070904
Name:CHENEY, DENVER
Entity Type:Individual
Prefix:
First Name:DENVER
Middle Name:
Last Name:CHENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 BIRCH PL
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4511
Mailing Address - Country:US
Mailing Address - Phone:612-207-1497
Mailing Address - Fax:
Practice Address - Street 1:3222 BIRCH PL
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-4511
Practice Address - Country:US
Practice Address - Phone:612-207-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0001058197OtherSUPPLIER NUMBER