1164422192 NPI number — DR. THOMAS JASON PERMENTER DC

Table of content: SARAH BOWMAN (NPI 1518408475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164422192 NPI number — DR. THOMAS JASON PERMENTER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERMENTER
Provider First Name:
THOMAS
Provider Middle Name:
JASON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1164422192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9123 MONROE RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28270-2456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-569-3130
Provider Business Mailing Address Fax Number:
704-569-9797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9123 MONROE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28270-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-569-3130
Provider Business Practice Location Address Fax Number:
704-569-9797
Provider Enumeration Date:
08/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2671 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7572054 . This is a "AETNA - PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 790838F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0838F . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 606834-980061 . This is a "ACN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NC3802 . This is a "PREFERRED CHIRO CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 963043003 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2117085094101 . This is a "BEECH STREET" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 56-2215329 . This is a "CNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 109362 . This is a "WELLNESS PLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3467419 . This is a "AETNA - HMO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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