Provider Demographics
NPI:1952375222
Name:PENWELL, NANCY L (DC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:PENWELL
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 1:2 N COUNTRY CLUB RD
Mailing Address - Street 2:STE 3
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-4161
Practice Address - Country:US
Practice Address - Phone:217-423-1500
Practice Address - Fax:217-423-1504
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5832064OtherBC/BS PROVIDER #
IL20-2712607OtherTAX ID NUMBER
IL5832064OtherBC/BS PROVIDER #