Provider Demographics
NPI:1831632215
Name:PENNELL, MATTHEW (DC, MS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:PENNELL
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15046 BELTWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3709
Mailing Address - Country:US
Mailing Address - Phone:972-409-6221
Mailing Address - Fax:214-593-3623
Practice Address - Street 1:15046 BELTWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3709
Practice Address - Country:US
Practice Address - Phone:972-409-6221
Practice Address - Fax:214-593-3623
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016402111NS0005X
TX14014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician