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NPI Code Detail

MEDICARE: DR. MARK JOSEPH PENSIS DC

MEDICARE: DR. MARK JOSEPH PENSIS 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
1111N00000XChiropractor2292-012WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2391524586016OTHERWIBLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1720085632
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK JOSEPH PENSIS DC
Provider Business Mailing Address
First Line : 275 S MAIN ST
Second Line : P. O. BOX 266
City : CLINTONVILLE
State : WI
Zip : 54929-1604
Country : US
Telephone Number : 715-823-2912
Fax Number : 715-823-1331
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 : 715-823-1331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 02/21/2008

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