Healthcare Provider Details

I. General information

NPI: 1457300220
Provider Name (Legal Business Name): DENNIS MJ HOMACK DC, MS, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 STATE ROUTE 89
SENECA FALLS NY
13148-9425
US

IV. Provider business mailing address

27 VAN RENSSALAER ST
SENECA FALLS NY
13148-1705
US

V. Phone/Fax

Practice location:
  • Phone: 315-568-3157
  • Fax: 315-568-3017
Mailing address:
  • Phone: 315-568-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX08680-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: