Provider Demographics
NPI:1326028267
Name:PENROD, MONTE J (DC)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:J
Last Name:PENROD
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 1:409 FOX RUN LN
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-6701
Mailing Address - Country:US
Mailing Address - Phone:828-817-9252
Mailing Address - Fax:828-859-7649
Practice Address - Street 1:409 FOX RUN LN
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-6701
Practice Address - Country:US
Practice Address - Phone:828-817-9252
Practice Address - Fax:828-859-7649
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU96515Medicare UPIN
NC2459691Medicare PIN