Traci Susanne Pennock, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3471 Issued in OH

Practice address

6730 Roosevelt Ave Ste 205
Middletown, OH 45005-5743

Phone

(513) 597-0605

NPI assigned

Feb 27, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1922277599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6730 ROOSEVELT AVE STE 205",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450055743",
            "telephone_number": "513-597-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6730 ROOSEVELT AVE STE 205",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "450055743",
            "telephone_number": "513-597-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNOCK",
        "first_name": "TRACI",
        "middle_name": "SUSANNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-27",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "3471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2852720",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Pendleton
• Wayne G Pendleton Jr.
• Evynn Pennington
• Timothy Mark Pennington, NP-C
• Tina Marie Pennington, LPN
• Percy D Mitchell Jr M D & Associates LLC
• Sharon K Perry, LSW
• Teresa Perry
• Pers Now, LLC
• Deanna Marie Persiani, DNP, FNP-BC, FNP-C

• Chiropractor in Middletown, OH
• Providers in Middletown, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.