Provider Demographics
NPI:1831430297
Name:PENNEY, HOLLIE (DC)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:PENNEY
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 1:401 BROADWAY ST S
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1701
Mailing Address - Country:US
Mailing Address - Phone:952-492-5253
Mailing Address - Fax:
Practice Address - Street 1:401 BROADWAY ST S
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1701
Practice Address - Country:US
Practice Address - Phone:952-492-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5786111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350005279Medicare PIN