Provider Demographics
NPI:1417063009
Name:ENCHANTE, PENE LEE (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:PENE
Middle Name:LEE
Last Name:ENCHANTE
Suffix:
Gender:F
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 HILL ST
Mailing Address - Street 2:P.O. BOX 130
Mailing Address - City:CASHTON
Mailing Address - State:WI
Mailing Address - Zip Code:54619-8040
Mailing Address - Country:US
Mailing Address - Phone:608-654-5401
Mailing Address - Fax:
Practice Address - Street 1:901 FRONT ST
Practice Address - Street 2:
Practice Address - City:CASHTON
Practice Address - State:WI
Practice Address - Zip Code:54619-2003
Practice Address - Country:US
Practice Address - Phone:608-654-5401
Practice Address - Fax:608-654-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU44676Medicare UPIN
WI000070702Medicare ID - Type Unspecified