Provider Demographics
NPI:1710042742
Name:PENSA, MICHAEL ANTONIO (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTONIO
Last Name:PENSA
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 1:45 EAGLE ST BLD J UNIT 100
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909
Mailing Address - Country:US
Mailing Address - Phone:401-272-1120
Mailing Address - Fax:401-272-1148
Practice Address - Street 1:45 EAGLE ST BLD J UNIT 100
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909
Practice Address - Country:US
Practice Address - Phone:401-272-1120
Practice Address - Fax:401-272-1148
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor