Provider Demographics
NPI:1639127640
Name:DENDE, NEIL T (DC)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:T
Last Name:DENDE
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 1:20100 N 51ST AVE STE B210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5096
Mailing Address - Country:US
Mailing Address - Phone:623-825-4444
Mailing Address - Fax:
Practice Address - Street 1:20100 N 51ST AVE STE B210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5096
Practice Address - Country:US
Practice Address - Phone:623-825-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3890111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC3890Medicare ID - Type Unspecified