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General NPI Number Information
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NPI Number | 1821331117
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Entity Type | Individual
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Provider Name | SCOTT CHARLES PENNEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 401 BROADWAY ST S
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City | JORDAN
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State | MN
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Zip | 55352-1701
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Country | US
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Telephone | 952-492-5253
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Fax | 952-456-6966
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Provider Business Mailing Address
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Address Line | 209 WATER ST
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City | JORDAN
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State | MN
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Zip | 55352-1518
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Country | US
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Telephone | 952-492-5253
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Fax | 952-456-6966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5879
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License Number State | MN
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