Provider Demographics
NPI:1386741924
Name:MOMYER, DENNIS R (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:MOMYER
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 1:1314 S KING ST
Mailing Address - Street 2:1564
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1956
Mailing Address - Country:US
Mailing Address - Phone:808-591-9339
Mailing Address - Fax:808-591-8731
Practice Address - Street 1:1314 S KING ST
Practice Address - Street 2:1564
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1956
Practice Address - Country:US
Practice Address - Phone:808-591-9339
Practice Address - Fax:808-591-8731
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC44111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIX5002-6OtherHMSA
HI0000QCBBMMedicare ID - Type Unspecified