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General NPI Number Information
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NPI Number | 1831632215
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Entity Type | Individual
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Provider Name | MATTHEW PENNELL D.C., M.S.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 15046 BELTWAY DR STE 101
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City | ADDISON
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State | TX
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Zip | 75001-3709
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Country | US
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Telephone | 972-409-6221
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Fax | 214-593-3623
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Provider Business Mailing Address
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Address Line | 15046 BELTWAY DR STE 101
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City | ADDISON
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State | TX
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Zip | 75001-3709
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Country | US
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Telephone | 972-409-6221
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Fax | 214-593-3623
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2015016402
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14014
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License Number State | TX
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