Provider Demographics
NPI:1356318695
Name:PENGE CHIROPRACTIC HEALTH CENTER PA
Entity Type:Organization
Organization Name:PENGE CHIROPRACTIC HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-365-4343
Mailing Address - Street 1:2727 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4524
Mailing Address - Country:US
Mailing Address - Phone:941-365-4343
Mailing Address - Fax:941-365-4838
Practice Address - Street 1:2727 S TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4524
Practice Address - Country:US
Practice Address - Phone:941-365-4343
Practice Address - Fax:941-365-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55152OtherBLUE CROSS BLUE SHIELD
FL350041825OtherRAILROAD MEDICARE
FL55152OtherBLUE CROSS BLUE SHIELD