Provider Demographics
NPI:1629297866
Name:STEPHEN J. PENNELL, D.C. PC
Entity Type:Organization
Organization Name:STEPHEN J. PENNELL, D.C. PC
Other - Org Name:PENNELL FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-776-5800
Mailing Address - Street 1:20421 ROUTE 19
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7513
Mailing Address - Country:US
Mailing Address - Phone:724-776-5800
Mailing Address - Fax:724-776-6682
Practice Address - Street 1:20421 ROUTE 19
Practice Address - Street 2:SUITE 100
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-7513
Practice Address - Country:US
Practice Address - Phone:724-776-5800
Practice Address - Fax:724-776-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2083L111N00000X
PADC2328L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA433913OtherHEALTHAMERICA
PA185337OtherHIGHMARK BCBS
PA268156OtherHIGHMARK BCBS
PA66681OtherUNITEDHEALTHCARE
PA336848OtherHEALTHAMERICA
PA433929OtherHEALTHAMERICA
PA151464Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
PA433929OtherHEALTHAMERICA
PA268156OtherHIGHMARK BCBS
PA185337Medicare ID - Type UnspecifiedMEDICARE ID NUMBER