1548485105 NPI number — PERMEN CHIROPRACTIC PLLC

Table of content: (NPI 1548485105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548485105 NPI number — PERMEN CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERMEN CHIROPRACTIC PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548485105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 BAY LYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98264-9464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-354-6800
Provider Business Mailing Address Fax Number:
360-937-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 BAY LYN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNDEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98264-9464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-354-6800
Provider Business Practice Location Address Fax Number:
360-937-1399
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERMEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
360-354-6800

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  001920 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 668920 . This is a "ACN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 653559 . This is a "ACN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0189056 . This is a "DLI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6020 . This is a "DLI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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