Provider Demographics
NPI:1174639686
Name:PENCE, JEFFREY A (DC CCSP CSCS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:PENCE
Suffix:
Gender:M
Credentials:DC CCSP CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 AGENCY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1908
Mailing Address - Country:US
Mailing Address - Phone:319-752-1460
Mailing Address - Fax:319-752-1461
Practice Address - Street 1:3115 AGENCY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1908
Practice Address - Country:US
Practice Address - Phone:319-752-1460
Practice Address - Fax:319-752-1461
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5225111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27073OtherWELLMARK BC/BS
IA350036056OtherRAILROAD MEDICARE
IA0270736Medicaid
IA350036056OtherRAILROAD MEDICARE
IAI15441Medicare ID - Type Unspecified