Provider Demographics
NPI:1538202668
Name:CONSTANTIN, PIERRE R (DC)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:R
Last Name:CONSTANTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:PIERRE
Other - Middle Name:R
Other - Last Name:CONSTANTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-1256
Mailing Address - Country:US
Mailing Address - Phone:360-312-4656
Mailing Address - Fax:360-392-8732
Practice Address - Street 1:2376 MAIN STREET, SUITE 1
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-1256
Practice Address - Country:US
Practice Address - Phone:360-312-4656
Practice Address - Fax:360-392-8732
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2091205Medicaid
WAT83843Medicare UPIN
WAAB18034Medicare ID - Type Unspecified