Provider Demographics
NPI:1336410547
Name:PENNEKAMP, AMANDA J (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:PENNEKAMP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1888
Mailing Address - Country:US
Mailing Address - Phone:608-316-6972
Mailing Address - Fax:608-231-9690
Practice Address - Street 1:2702 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1888
Practice Address - Country:US
Practice Address - Phone:608-316-6972
Practice Address - Fax:608-231-9690
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor