Healthcare Provider Details

I. General information

NPI: 1043211485
Provider Name (Legal Business Name): BRUCE E DENTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4167 E. HITT STREET
MT. MORRIS IL
61054
US

IV. Provider business mailing address

4167 E. HITT STREET
MT. MORRIS IL
61054
US

V. Phone/Fax

Practice location:
  • Phone: 815-734-7347
  • Fax: 815-734-6230
Mailing address:
  • Phone: 815-734-7347
  • Fax: 815-734-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: