Provider Demographics
NPI:1508940156
Name:TALL, DENNIS HOWARD (DC, RN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:HOWARD
Last Name:TALL
Suffix:
Gender:M
Credentials:DC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2727
Mailing Address - Country:US
Mailing Address - Phone:541-664-5253
Mailing Address - Fax:541-664-1165
Practice Address - Street 1:990 S FRONT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2727
Practice Address - Country:US
Practice Address - Phone:541-664-5253
Practice Address - Fax:541-664-1165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-1307154OtherTAX ID NUMBER
ORR112291 PROVIDERMedicare PIN
ORR112290Medicare PIN
ORU17719Medicare UPIN