Provider Demographics
NPI:1821179466
Name:BARRY D. PENNEY, DC, INC.
Entity Type:Organization
Organization Name:BARRY D. PENNEY, DC, INC.
Other - Org Name:PENNEY CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-762-4796
Mailing Address - Street 1:312 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-2702
Mailing Address - Country:US
Mailing Address - Phone:870-762-4796
Mailing Address - Fax:870-762-5036
Practice Address - Street 1:312 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2702
Practice Address - Country:US
Practice Address - Phone:870-762-4796
Practice Address - Fax:870-762-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1445111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00305651OtherRAILROAD MEDICARE PIN
AR5F169OtherBLUE CROSS/ BLUE SHIELD
ARDE6379OtherRAILROAD MEDICARE GROUP #
AR06010015700OtherQUALCHOICE/QCA
AR5F169Medicare ID - Type UnspecifiedPROVIDER NUMBER