Provider Demographics
NPI:1992811590
Name:OGRODOWCZYK, DENNIS JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
Last Name:OGRODOWCZYK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 STATE ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-3348
Mailing Address - Country:US
Mailing Address - Phone:423-949-3900
Mailing Address - Fax:423-949-3912
Practice Address - Street 1:318 STATE ROUTE 8
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-3348
Practice Address - Country:US
Practice Address - Phone:423-949-3900
Practice Address - Fax:423-949-3912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673982Medicaid
TNT74639Medicare UPIN
TN3673982Medicare ID - Type Unspecified