Provider Demographics
NPI:1447246939
Name:GILLENWATER, DENNIS M (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:GILLENWATER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 W 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-6618
Mailing Address - Country:US
Mailing Address - Phone:316-943-3251
Mailing Address - Fax:
Practice Address - Street 1:2909 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-6618
Practice Address - Country:US
Practice Address - Phone:316-943-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC3618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T43820Medicare UPIN
KS060936Medicare ID - Type Unspecified