Provider Demographics
NPI:1639146970
Name:PENGE, JOSEPH J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:PENGE
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 1:2727 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4524
Mailing Address - Country:US
Mailing Address - Phone:941-365-4343
Mailing Address - Fax:941-365-4838
Practice Address - Street 1:2727 S TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4524
Practice Address - Country:US
Practice Address - Phone:941-365-4343
Practice Address - Fax:941-365-4838
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55152OtherBLUE CROSS BLUE SHIELD
FL350041825OtherRAILROAD MEDICARE
FLU45157Medicare UPIN
FL55152AMedicare ID - Type Unspecified