Provider Demographics
NPI:1427009422
Name:PENNEBAKER, DAVID CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:PENNEBAKER
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 1:14231 N 7TH ST STE 5A
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4362
Mailing Address - Country:US
Mailing Address - Phone:602-943-0213
Mailing Address - Fax:602-943-6919
Practice Address - Street 1:14231 N 7TH 5A
Practice Address - Street 2:SUITE 5A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4362
Practice Address - Country:US
Practice Address - Phone:602-943-0213
Practice Address - Fax:602-943-6919
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ$$$$$$$$$Medicare PIN