Provider Demographics
NPI:1053422089
Name:MULCAHY, DENNIS M (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:MULCAHY
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 1:2336 MACK RD STE K
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4898
Mailing Address - Country:US
Mailing Address - Phone:513-829-1991
Mailing Address - Fax:513-829-1974
Practice Address - Street 1:2336 MACK RD STE K
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4898
Practice Address - Country:US
Practice Address - Phone:513-829-1991
Practice Address - Fax:513-829-1974
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0780285Medicaid
OHMU0664751Medicare ID - Type Unspecified
OH0780285Medicaid