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NPI Code Detail

MEDICARE: ROGER M. PENNA D.C.

MEDICARE: ROGER M. PENNA D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician ChiropractorB598NV
2111N00000XChiropractorB598NV

General Provider Information

NPI Number : 1306899489
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER M. PENNA D.C.
Provider Business Mailing Address
First Line : 2590 NATURE PARK DR STE 135
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-3187
Country : US
Telephone Number : 702-636-2843
Fax Number : 702-726-9543
Provider Business Practice Location Address
First Line : 2670 CRIMSON CANYON DR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0848
Country : US
Telephone Number : 702-232-3189
Fax Number : 702-233-6713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 12/01/2022

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Directions to “ ROGER M. PENNA D.C.” Practice Location

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