Provider Demographics
NPI:1881729143
Name:DENNER, KEVIN ROSS (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROSS
Last Name:DENNER
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 1:37339 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1664
Mailing Address - Country:US
Mailing Address - Phone:906-202-3295
Mailing Address - Fax:
Practice Address - Street 1:37339 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-1664
Practice Address - Country:US
Practice Address - Phone:906-202-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950Z21002OtherBCBS ID