MEDICARE: DR. MATTHEW ANTHONY PENNETTI 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	111N00000X	Chiropractor	CHR.0007743	CO

General Provider Information

NPI Number	:	1447740691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW ANTHONY PENNETTI DC

Provider Business Mailing Address
First Line	:	5956 S HOLLY ST
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4221
Country	:	US
Telephone Number	:	720-676-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	5956 S HOLLY ST
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4221
Country	:	US
Telephone Number	:	720-676-6440
Fax Number	:

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

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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