Provider Demographics
NPI:1659580165
Name:PEPELNJAK, JOHN WILLIAM III (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:PEPELNJAK
Suffix:III
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 1:1522 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1634
Mailing Address - Country:US
Mailing Address - Phone:218-724-4077
Mailing Address - Fax:218-724-3045
Practice Address - Street 1:1522 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1634
Practice Address - Country:US
Practice Address - Phone:218-724-4077
Practice Address - Fax:218-724-3045
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38959800Medicaid
7640075OtherMN TIN
338L6PEOtherTWO HARBORS BCBS
443L0PEOtherDULUTH BCBS