MEDICARE: STEPHEN J. PENNELL, D.C. PC

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
1	111N00000X	Chiropractor	DC2328L	PA
2	111N00000X	Chiropractor	DC2083L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	433913	OTHER	PA	HEALTHAMERICA
2	185337	OTHER	PA	HIGHMARK BCBS
3	268156	OTHER	PA	HIGHMARK BCBS
4	66681	OTHER	PA	UNITEDHEALTHCARE
5	336848	OTHER	PA	HEALTHAMERICA
6	433929	OTHER	PA	HEALTHAMERICA

General Provider Information

NPI Number	:	1629297866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN J. PENNELL, D.C. PC

Provider Business Mailing Address
First Line	:	20421 ROUTE 19
Second Line	:	SUITE 100
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-7513
Country	:	US
Telephone Number	:	724-776-5800
Fax Number	:	724-776-6682

Provider Business Practice Location Address
First Line	:	20421 ROUTE 19
Second Line	:	SUITE 100
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-7513
Country	:	US
Telephone Number	:	724-776-5800
Fax Number	:	724-776-6682

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN J PENNELL
Credential	:	D.C.
Telephone Number	:	724-776-5800

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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