Provider Demographics
NPI:1487197000
Name:MUNK, DENNIS JOHN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JOHN
Last Name:MUNK
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7903 W 19TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1499
Mailing Address - Country:US
Mailing Address - Phone:316-214-1866
Mailing Address - Fax:
Practice Address - Street 1:7903 W 19TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1499
Practice Address - Country:US
Practice Address - Phone:316-214-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-004222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer