Provider Demographics
NPI:1548485105
Name:PERMEN CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:PERMEN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERMEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-354-6800
Mailing Address - Street 1:260 BAY LYN DR
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9464
Mailing Address - Country:US
Mailing Address - Phone:360-354-6800
Mailing Address - Fax:360-937-1399
Practice Address - Street 1:260 BAY LYN DR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9464
Practice Address - Country:US
Practice Address - Phone:360-354-6800
Practice Address - Fax:360-937-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA001920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA668920OtherACN
WA653559OtherACN
WA0189056OtherDLI
WA6020OtherDLI
WA8806685Medicare ID - Type Unspecified
WAGAB 16796Medicare ID - Type Unspecified