Provider Demographics
NPI:1316243397
Name:DENNISON, ADAM S (DC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:S
Last Name:DENNISON
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 1:1970 OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3304
Mailing Address - Country:US
Mailing Address - Phone:703-910-6768
Mailing Address - Fax:703-910-7431
Practice Address - Street 1:1970 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3304
Practice Address - Country:US
Practice Address - Phone:703-910-6768
Practice Address - Fax:703-910-7431
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104556866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB762Medicare PIN