Provider Demographics
NPI:1851330161
Name:HASKINS, DENNIS KEITH (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:KEITH
Last Name:HASKINS
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 1:2141 CASS LAKE ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320
Mailing Address - Country:US
Mailing Address - Phone:248-462-5621
Mailing Address - Fax:
Practice Address - Street 1:2141 CASS LAKE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1270
Practice Address - Country:US
Practice Address - Phone:248-462-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDH004032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33644OtherBCBS
MIU70620Medicare UPIN
MI0F33644OtherBCBS