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 1:105 CLARMAR DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2675
Mailing Address - Country:US
Mailing Address - Phone:608-318-5929
Mailing Address - Fax:608-318-5922
Practice Address - Street 1:204 W COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9211
Practice Address - Country:US
Practice Address - Phone:608-839-1172
Practice Address - Fax:608-839-1174
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor