MEDICARE: JAMIE J PENN 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
1	111N00000X	Chiropractor	2301009723	MI

General Provider Information

NPI Number	:	1689981300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE J PENN D.C.

Provider Business Mailing Address
First Line	:	7838 5 MILE RD
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48168-9448
Country	:	US
Telephone Number	:	734-306-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 N LAFAYETTE ST
Second Line	:
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-4002
Country	:	US
Telephone Number	:	734-306-2454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	04/12/2012

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