Provider Demographics
NPI:1023337201
Name:PENILLA, MICHAEL HECTOR (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HECTOR
Last Name:PENILLA
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 1:1265 N LA CADENA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2455
Mailing Address - Country:US
Mailing Address - Phone:909-423-0000
Mailing Address - Fax:
Practice Address - Street 1:1265 N LA CADENA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2455
Practice Address - Country:US
Practice Address - Phone:909-423-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20484111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner