Provider Demographics
NPI:1083786396
Name:PENNIX, FRAN (DC)
Entity Type:Individual
Prefix:DR
First Name:FRAN
Middle Name:
Last Name:PENNIX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 S SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2968
Mailing Address - Country:US
Mailing Address - Phone:630-832-8367
Mailing Address - Fax:
Practice Address - Street 1:443 S SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2968
Practice Address - Country:US
Practice Address - Phone:630-832-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
394130Medicare ID - Type Unspecified