Doctor Name: | DR. BRIAN DAVID PENWELL |
NPI Number: | 1568436624 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.C. |
License Number: | |
Business Practice Address: | 2 N Country Club Rd Suite 3 Decatur, IL - 625214161 |
Business Phone Number: | 2174231500 |
Business Fax Number: | 2174231504 |
Mailing Address: | 3300 Salem School Rd, DECATUR |
State: | IL |
Postal Code: | 625218853 |
Phone Number: | 2178649082 |
Fax Number: | |
NPI Enumeration Date: | 02/15/2006 |
NPI Last Update Date: | 11/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |