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General NPI Number Information
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NPI Number | 1558429613
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Entity Type | Organization
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Legal Business Name | MARK J. PENSIS CHIROPRACTIC, S.C.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 275 S MAIN ST
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City | CLINTONVILLE
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State | WI
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Zip | 54929-1604
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Country | US
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Telephone | 715-823-2912
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 266
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City | CLINTONVILLE
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State | WI
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Zip | 54929-0266
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Country | US
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Telephone | 715-823-2912
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHANNON HELEN TREMPER
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Credential |
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Telephone | 715-823-2912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2292-012
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License Number State | WI
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