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NPI Code Detail

MEDICARE: DR. DAVID JOHN PENNELL AC,PHYS.,L.M.T.

MEDICARE:  DR. DAVID JOHN PENNELL  AC,PHYS.,L.M.T.
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
1171100000XAcupuncturistAP215FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C0079OTHERFLBLUE CROSS BLUE SHIELD PROVIDER ID

General Provider Information

NPI Number : 1013267277
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID JOHN PENNELL AC,PHYS.,L.M.T.
Provider Business Mailing Address
First Line : 4701 NORTH FEDERAL HWY STE 311
Second Line :
City : POMPANO
State : FL
Zip : 33064-6562
Country : US
Telephone Number : 954-993-7502
Fax Number :
Provider Business Practice Location Address
First Line : 4701 N FEDERAL HWY STE 311
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33064-6548
Country : US
Telephone Number : 954-993-7502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2012
Last Update Date : 09/14/2012

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