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NPI Code Detail

MEDICARE: MARK J. PENSIS CHIROPRACTIC, S.C.

MEDICARE: MARK J. PENSIS CHIROPRACTIC, S.C.
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
1111N00000XChiropractor2292-012WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1391524586016OTHERWIBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
36264OTHERWINETWORK

General Provider Information

NPI Number : 1558429613
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK J. PENSIS CHIROPRACTIC, S.C.
Provider Business Mailing Address
First Line : PO BOX 266
Second Line :
City : CLINTONVILLE
State : WI
Zip : 54929-0266
Country : US
Telephone Number : 715-823-2912
Fax Number :
Provider Business Practice Location Address
First Line : 275 S MAIN ST
Second Line :
City : CLINTONVILLE
State : WI
Zip : 54929-1604
Country : US
Telephone Number : 715-823-2912
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. SHANNON HELEN TREMPER
Credential :
Telephone Number : 715-823-2912
Provider Enumeration Date : 12/04/2006
Last Update Date : 08/22/2020

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