Provider Demographics
NPI:1427051192
Name:HARPER, DENNIS LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:HARPER
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:PO BOX 1061
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1061
Mailing Address - Country:US
Mailing Address - Phone:208-476-3158
Mailing Address - Fax:208-476-7818
Practice Address - Street 1:10620 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9372
Practice Address - Country:US
Practice Address - Phone:208-476-3158
Practice Address - Fax:208-476-7818
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002612200Medicaid
ID002612200Medicaid
ID1671579Medicare ID - Type Unspecified