Provider Demographics
NPI:1538448584
Name:PLOCH, PENNY LOU (DC)
Entity type:Individual
Prefix:DR
First Name:PENNY
Middle Name:LOU
Last Name:PLOCH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PENNY
Other - Middle Name:PLOCH
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:958 S KENMORE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-7513
Mailing Address - Country:US
Mailing Address - Phone:812-477-5003
Mailing Address - Fax:812-477-3639
Practice Address - Street 1:958 S KENMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7513
Practice Address - Country:US
Practice Address - Phone:812-477-5003
Practice Address - Fax:812-477-3639
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000870A111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08000870AOtherSTATE OF IN PROFESSIONAL LICENSE