Healthcare Provider Details

I. General information

NPI: 1033284955
Provider Name (Legal Business Name): DANIEL SCOTT PENNINGTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MAIN STREET
BRAYMER MO
64624
US

IV. Provider business mailing address

PO BOX 442
BRAYMER MO
64624-0442
US

V. Phone/Fax

Practice location:
  • Phone: 660-645-2011
  • Fax: 660-645-2011
Mailing address:
  • Phone: 660-645-2011
  • Fax: 660-645-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number116301
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: