Provider Demographics
NPI:1700977527
Name:TILLOTSON, DENNIS DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DEAN
Last Name:TILLOTSON
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 1:101 NORTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2924
Mailing Address - Country:US
Mailing Address - Phone:361-576-4325
Mailing Address - Fax:361-576-9793
Practice Address - Street 1:101 NORTH PARK DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2924
Practice Address - Country:US
Practice Address - Phone:361-576-4325
Practice Address - Fax:361-576-9793
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4615111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06018631Medicaid
TXC06018631Medicaid
601863Medicare ID - Type Unspecified