Provider Demographics
NPI:1013267277
Name:PENNELL, DAVID JOHN (AC,PHYS,LMT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:PENNELL
Suffix:
Gender:M
Credentials:AC,PHYS,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 NORTH FEDERAL HWY STE 311
Mailing Address - Street 2:
Mailing Address - City:POMPANO
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6562
Mailing Address - Country:US
Mailing Address - Phone:954-993-7502
Mailing Address - Fax:
Practice Address - Street 1:4701 N FEDERAL HWY STE 311
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6548
Practice Address - Country:US
Practice Address - Phone:954-993-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP215171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0079OtherBLUE CROSS BLUE SHIELD PROVIDER ID