Provider Demographics
NPI:1205874922
Name:PENNY, TREVER JAY (DC)
Entity type:Individual
Prefix:
First Name:TREVER
Middle Name:JAY
Last Name:PENNY
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 1:6601 W BETHANY HOME ROAD
Mailing Address - Street 2:SUITE #A10
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301
Mailing Address - Country:US
Mailing Address - Phone:623-463-1000
Mailing Address - Fax:623-463-1111
Practice Address - Street 1:6601 W BETHANY HOME ROAD
Practice Address - Street 2:SUITE #A10
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301
Practice Address - Country:US
Practice Address - Phone:623-463-1000
Practice Address - Fax:623-463-1111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U77604Medicare UPIN
107047Medicare ID - Type Unspecified