Provider Demographics
NPI:1295991560
Name:DENNIS, DONALD WAYMON JR (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYMON
Last Name:DENNIS
Suffix:JR
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 1:603 HUNT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1117
Mailing Address - Country:US
Mailing Address - Phone:253-891-9102
Mailing Address - Fax:
Practice Address - Street 1:603 HUNT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1117
Practice Address - Country:US
Practice Address - Phone:253-891-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor