Provider Demographics
NPI:1174611396
Name:DENIS, PAUL B (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:DENIS
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 1:5120 CHARLESTOWN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9497
Mailing Address - Country:US
Mailing Address - Phone:812-944-8000
Mailing Address - Fax:812-944-8992
Practice Address - Street 1:5120 CHARLESTOWN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9497
Practice Address - Country:US
Practice Address - Phone:812-944-8000
Practice Address - Fax:812-944-8992
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001418A111NR0200X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232260Medicare PIN
INU47308Medicare UPIN
IN232260AMedicare PIN