Healthcare Provider Details

I. General information

NPI: 1699744003
Provider Name (Legal Business Name): DENNIS JAMES LENCIONI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 OGDEN AVE APARTMENT 7
LYONS IL
60534-1072
US

IV. Provider business mailing address

8735 OGDEN AVE APARTMENT 7
LYONS IL
60534-1072
US

V. Phone/Fax

Practice location:
  • Phone: 708-442-7912
  • Fax:
Mailing address:
  • Phone: 708-442-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096-000030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: