Provider Demographics
NPI:1558429613
Name:MARK J. PENSIS CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:MARK J. PENSIS CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:TREMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-823-2912
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-0266
Mailing Address - Country:US
Mailing Address - Phone:715-823-2912
Mailing Address - Fax:
Practice Address - Street 1:275 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1604
Practice Address - Country:US
Practice Address - Phone:715-823-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2292-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391524586016OtherBLUE CROSS
WI38833800Medicaid
WI6264OtherNETWORK