Provider Demographics
NPI:1932209285
Name:LIBENGOOD, DENNIS P (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:LIBENGOOD
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 1:550 OHIO PIKE
Mailing Address - Street 2:SUITE 121-F
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3315
Mailing Address - Country:US
Mailing Address - Phone:513-947-9355
Mailing Address - Fax:513-947-0190
Practice Address - Street 1:550 OHIO PIKE
Practice Address - Street 2:SUITE 121-F
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3315
Practice Address - Country:US
Practice Address - Phone:513-947-9355
Practice Address - Fax:513-947-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2013421Medicaid
OH0836861Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHU68331Medicare UPIN