Provider Demographics
NPI:1346418563
Name:PENROD, STEPHEN D (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
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 1:3027 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27263-1969
Mailing Address - Country:US
Mailing Address - Phone:336-431-2111
Mailing Address - Fax:
Practice Address - Street 1:3027 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-1969
Practice Address - Country:US
Practice Address - Phone:336-431-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC801111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244156Medicare PIN