Provider Demographics
NPI:1649342593
Name:DENNIS, DAMON M (DC)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:M
Last Name:DENNIS
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:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-0788
Mailing Address - Country:US
Mailing Address - Phone:913-837-2910
Mailing Address - Fax:913-837-2910
Practice Address - Street 1:11 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053
Practice Address - Country:US
Practice Address - Phone:913-837-2910
Practice Address - Fax:913-837-2910
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU31545Medicare UPIN
KS023737Medicare ID - Type Unspecified