Provider Demographics
NPI:1871786277
Name:PENMAN CHIROPRACTIC
Entity type:Organization
Organization Name:PENMAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-439-2709
Mailing Address - Street 1:5898 OMAHA AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4383
Mailing Address - Country:US
Mailing Address - Phone:651-439-2709
Mailing Address - Fax:651-439-7553
Practice Address - Street 1:5898 OMAHA AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4383
Practice Address - Country:US
Practice Address - Phone:651-439-2709
Practice Address - Fax:651-439-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1299261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3883155Medicaid