Provider Demographics
NPI:1447786074
Name:PENNIMAN, GAIL
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:PENNIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2745 PORTER ST
Mailing Address - Street 2:STE D
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2471
Mailing Address - Country:US
Mailing Address - Phone:831-419-8548
Mailing Address - Fax:
Practice Address - Street 1:2745 PORTER ST
Practice Address - Street 2:STE D
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2471
Practice Address - Country:US
Practice Address - Phone:831-419-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11802111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic