Provider Demographics
NPI:1114152865
Name:UNIVERSITY CHIROPRACTIC
Entity Type:Organization
Organization Name:UNIVERSITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PENSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-272-1120
Mailing Address - Street 1:45 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1082
Mailing Address - Country:US
Mailing Address - Phone:401-272-1120
Mailing Address - Fax:401-272-1148
Practice Address - Street 1:45 EAGLE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1082
Practice Address - Country:US
Practice Address - Phone:401-272-1120
Practice Address - Fax:401-272-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709003968Medicare PIN