Individual
DR. MARYGRACE PENNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
9780 LANTERN RD, SUITE 230, FISHERS, IN 46037-4092
(317) 863-0365
Mailing address
9780 LANTERN RD, SUITE 230, FISHERS, IN 46037-4092
(317) 863-0365
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001966A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200316610A
—
IN
Enumeration date
03/28/2007
Last updated
07/08/2007
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