Blake Robert Pennock II, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

8787 Issued in AZ

Practice address

1501 S Yale St Ste 250
Flagstaff, AZ 86001-7336

Phone

(928) 557-0707

NPI assigned

Feb 13, 2019

Last updated

Feb 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innove Chiro and Rehab, PLLC

  • Chiropractor
  • Fort Lauderdale, FL
  • NPI 1154021475
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1053877159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W BASELINE RD APT 2142",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852835319",
            "telephone_number": "563-249-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S YALE ST STE 250",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860017336",
            "telephone_number": "928-557-0707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNOCK",
        "first_name": "BLAKE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-13",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "8787",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Codey Todd Pedersen, DO
• Desmyn Pedersen, DO
• Abigail R Pederson, LAC
• Paula Pelletier-Butler, DM, MS, LM
• Yi-Hsuan Peng, BCBA
• Dakota Lynn Penrod, SLPA
• Robyn Esperanza Pensinger, RN
• Emily Michelle Caskey Peppers
• Marlene Perez
• Cori Kay Perkins, EDD

• Chiropractor in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.