Provider Demographics
NPI:1255517447
Name:SPAIN, DENNIS PATRICK (LAC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PATRICK
Last Name:SPAIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-1275 KAOMOLOA RD
Mailing Address - Street 2:P.O.BOX 6838
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743
Mailing Address - Country:US
Mailing Address - Phone:808-987-0945
Mailing Address - Fax:
Practice Address - Street 1:67-1275 KAOMOLOA RD
Practice Address - Street 2:6838 BOX NUMBER
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8414
Practice Address - Country:US
Practice Address - Phone:808-987-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI389171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist