Provider Demographics
NPI:1730362393
Name:DENNIS, JERAL KEILSHA (DC)
Entity type:Individual
Prefix:DR
First Name:JERAL
Middle Name:KEILSHA
Last Name:DENNIS
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 1:620 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2272
Mailing Address - Country:US
Mailing Address - Phone:231-922-0233
Mailing Address - Fax:231-941-9832
Practice Address - Street 1:620 2ND ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2272
Practice Address - Country:US
Practice Address - Phone:231-922-0233
Practice Address - Fax:231-941-9832
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor