Healthcare Provider Details

I. General information

NPI: 1952306078
Provider Name (Legal Business Name): DENNIS PATRICK MOLLOY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date: 03/18/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

201 US HIGHWAY 45 STE A
VERNON HILLS IL
60061-2300
US

IV. Provider business mailing address

201 US HIGHWAY 45 STE A
VERNON HILLS IL
60061-2300
US

V. Phone/Fax

Practice location:
  • Phone: 847-367-7070
  • Fax: 847-367-7090
Mailing address:
  • Phone: 847-367-7070
  • Fax: 847-367-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-005330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: