Provider Demographics
NPI:1558617787
Name:PENTZ, T. CRAIG (DC)
Entity Type:Individual
Prefix:DR
First Name:T. CRAIG
Middle Name:
Last Name:PENTZ
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 1:10 COMMERCE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4802
Mailing Address - Country:US
Mailing Address - Phone:860-430-9116
Mailing Address - Fax:
Practice Address - Street 1:1706 OLD TROLLEY RD STE F
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9035
Practice Address - Country:US
Practice Address - Phone:843-879-9824
Practice Address - Fax:843-879-9827
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010627111N00000X
CT1951111N00000X
SC3989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor