Provider Demographics
NPI:1952306078
Name:MOLLOY, DENNIS PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:PATRICK
Last Name:MOLLOY
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 1:201 US HIGHWAY 45
Mailing Address - Street 2:STE A
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2300
Mailing Address - Country:US
Mailing Address - Phone:847-367-7070
Mailing Address - Fax:847-367-7090
Practice Address - Street 1:201 US HIGHWAY 45
Practice Address - Street 2:STE A
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2300
Practice Address - Country:US
Practice Address - Phone:847-367-7070
Practice Address - Fax:847-367-7090
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2012-09-07
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IL038-005330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38514Medicare UPIN
IL750980Medicare ID - Type Unspecified