Provider Demographics
NPI:1922137165
Name:DENNING, KEITH RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:RANDALL
Last Name:DENNING
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 1:2202 PRAIRIE VW
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8170
Mailing Address - Country:US
Mailing Address - Phone:248-331-7239
Mailing Address - Fax:
Practice Address - Street 1:801 W BIG BEAVER RD STE 300
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4725
Practice Address - Country:US
Practice Address - Phone:248-515-5852
Practice Address - Fax:248-254-7462
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N30200002Medicare ID - Type Unspecified
MIU99712Medicare UPIN