Provider Demographics
NPI:1104083195
Name:PANEK, DAVID LEE (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:PANEK
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 1:3411 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3265
Mailing Address - Country:US
Mailing Address - Phone:810-767-6221
Mailing Address - Fax:810-767-4429
Practice Address - Street 1:3411 CORUNNA RD.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3265
Practice Address - Country:US
Practice Address - Phone:810-767-6221
Practice Address - Fax:810-767-4429
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23010002905111N00000X
MI2301009408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3$$$$$$$$$Medicaid
MI3$$$$$$$$$Medicaid