MEDICARE: DR. STEPHEN PENNOCK D.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
1	111N00000X	Chiropractor	3470	OH

General Provider Information

NPI Number	:	1871770826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PENNOCK D.C.

Provider Business Mailing Address
First Line	:	8102 BECKETT CENTER DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-5015
Country	:	US
Telephone Number	:	513-860-3200
Fax Number	:	513-860-5354

Provider Business Practice Location Address
First Line	:	8102 BECKETT CENTER DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-5015
Country	:	US
Telephone Number	:	513-860-3200
Fax Number	:	513-860-5354

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

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	01/22/2008

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