Provider Demographics
NPI:1497811947
Name:JANSSEN, DEAN R (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:R
Last Name:JANSSEN
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 1:850 AQUIDNECK AVE
Mailing Address - Street 2:SUITE B-12
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7244
Mailing Address - Country:US
Mailing Address - Phone:401-847-5311
Mailing Address - Fax:401-847-5342
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:SUITE B-12
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7244
Practice Address - Country:US
Practice Address - Phone:401-847-5311
Practice Address - Fax:401-847-5342
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 356111N00000X
FLCH 7285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26631 0OtherBLUE CROSS BLUE SHIELD
RIU-69352Medicare UPIN