Provider Demographics
NPI:1740390871
Name:DENNEHY, JOHN A JR (DC PC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DENNEHY
Suffix:JR
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NORTHPORT PLZ
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2269
Mailing Address - Country:US
Mailing Address - Phone:573-221-2001
Mailing Address - Fax:573-221-3316
Practice Address - Street 1:15 NORTHPORT PLZ
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2269
Practice Address - Country:US
Practice Address - Phone:573-221-2001
Practice Address - Fax:573-221-3316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1356658553OtherNPI
MO5580OtherBLUE CROSS BLUE SHIELD