Provider Demographics
NPI:1912024985
Name:JOHN, DALE KENT (DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:KENT
Last Name:JOHN
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 1:6610 N 47TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-4163
Mailing Address - Country:US
Mailing Address - Phone:623-931-7465
Mailing Address - Fax:623-842-0499
Practice Address - Street 1:6610 N 47TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-4163
Practice Address - Country:US
Practice Address - Phone:623-931-7465
Practice Address - Fax:623-842-0499
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor