Provider Demographics
NPI:1578650172
Name:PENA, STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:PENA
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:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:NH
Mailing Address - Zip Code:03608-0478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:NH
Practice Address - Zip Code:03608-0478
Practice Address - Country:US
Practice Address - Phone:603-756-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH248-1086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH050272440NH01OtherANTHEM PROVIDER BILLING #
NH30003109Medicaid
NHPENA0069039OtherBCBSVT PROVIDER BILLING #
NH00069039OtherBCBS-VERMONT PROVIDER NUM
NH0272400OtherANTHEM PROVIDER #
NH050272440NH01OtherANTHEM PROVIDER BILLING #
NHPENA0069039OtherBCBSVT PROVIDER BILLING #