MEDICARE: DR. DEBRA M PENTZ DC

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
1	111NR0400X	Rehabilitation Chiropractor	6001	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5469728	OTHER	AZ	CCN
2	AZ0248720	OTHER	AZ	BCBS
3	2150605	OTHER	AZ	1ST HEALTH

General Provider Information

NPI Number	:	1134276256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA M PENTZ DC

Provider Business Mailing Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 123
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4391
Country	:	US
Telephone Number	:	480-833-0302
Fax Number	:	480-494-5770

Provider Business Practice Location Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 123
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4391
Country	:	US
Telephone Number	:	480-833-0302
Fax Number	:	480-494-5770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/21/2022

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Directions to “ DR. DEBRA M PENTZ DC” Practice Location

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