Active NPI
Beverly Jean Pencek, D.C.
- Chiropractor
- PT. Reyes Station, CA
National Provider Identifier
1508937194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 26914
- Practice address
- 11100 Shoreline Hwy
PT Reyes Station, CA 94956 - Phone
- (415) 663-8442
- Fax
- (415) 663-1842
- NPI assigned
- Nov 13, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 26914 | CA | Primary |
Addresses
Primary practice location
11100 Shoreline Hwy
PT Reyes Station, CA 94956
Mailing address
11100 State Route 1
PO Box 236
PT Reyes Station, CA 94956
Phone (415) 663-8442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26914 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508937194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11100 STATE ROUTE 1",
"address_2": "PO BOX 236",
"city": "PT REYES STATION",
"state": "CA",
"postal_code": "94956",
"telephone_number": "415-663-8442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11100 SHORELINE HWY",
"city": "PT REYES STATION",
"state": "CA",
"postal_code": "94956",
"telephone_number": "415-663-8442",
"fax_number": "415-663-1842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENCEK",
"first_name": "BEVERLY",
"middle_name": "JEAN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "26914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in PT. Reyes Station, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.