Provider Demographics
NPI:1720050305
Name:SHORT, DENNIS RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RICHARD
Last Name:SHORT
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 1:584 ROUTES 6 AND 209
Mailing Address - Street 2:STE 1
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9401
Mailing Address - Country:US
Mailing Address - Phone:570-296-3000
Mailing Address - Fax:570-296-3000
Practice Address - Street 1:584 ROUTES 6 AND 209
Practice Address - Street 2:STE 1
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9401
Practice Address - Country:US
Practice Address - Phone:570-296-3000
Practice Address - Fax:570-296-3000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC07561L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028165Medicare ID - Type Unspecified