Provider Demographics
NPI:1063852390
Name:PENKIN, MICHAEL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:PENKIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 ELMWOOD AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3429
Mailing Address - Country:US
Mailing Address - Phone:585-444-7325
Mailing Address - Fax:585-991-6656
Practice Address - Street 1:1655 ELMWOOD AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3429
Practice Address - Country:US
Practice Address - Phone:585-444-7325
Practice Address - Fax:585-991-6656
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012367-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor