Provider Demographics
NPI:1598132995
Name:PENN, PAUL F JR (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:PENN
Suffix:JR
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:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-7219
Mailing Address - Country:US
Mailing Address - Phone:404-766-0676
Mailing Address - Fax:
Practice Address - Street 1:3433 MAIN ST
Practice Address - Street 2:B
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-1911
Practice Address - Country:US
Practice Address - Phone:404-766-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002655111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner