Healthcare Provider Details

I. General information

NPI: 1417233461
Provider Name (Legal Business Name): RICHARD TYLER DENNIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-063 HAUULA HOMESTEAD RD UNIT C
HAUULA HI
96717-9641
US

IV. Provider business mailing address

PO BOX 393
LAIE HI
96762-0393
US

V. Phone/Fax

Practice location:
  • Phone: 808-391-4064
  • Fax:
Mailing address:
  • Phone: 808-391-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1215
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC1215
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC1215
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: