Provider Demographics
NPI:1801384573
Name:PENLAND, JOHN R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:PENLAND
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 1:2516 SW 52ND TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7604
Mailing Address - Country:US
Mailing Address - Phone:305-877-1369
Mailing Address - Fax:
Practice Address - Street 1:2516 SW 52ND TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-7604
Practice Address - Country:US
Practice Address - Phone:305-877-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor