Provider Demographics
NPI:1831871557
Name:WERRY, DENNIS G JR (LAC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:WERRY
Suffix:JR
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 1:209 KEAYES AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2748
Mailing Address - Country:US
Mailing Address - Phone:309-839-0196
Mailing Address - Fax:
Practice Address - Street 1:209 KEAYES AVE
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2748
Practice Address - Country:US
Practice Address - Phone:309-839-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001590171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist