Individual
DR. BRIAN DAVID PENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2 N COUNTRY CLUB RD, SUITE 3, DECATUR, IL 62521-4161
(217) 423-1500
(217) 423-1504
Mailing address
3300 SALEM SCHOOL RD, DECATUR, IL 62521-8853
(217) 864-9082
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5806100
BLUECROSS BLUESHIELD
IL
Enumeration date
02/15/2006
Last updated
11/30/2007
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