Provider Demographics
NPI:1003917329
Name:PERMEN, JOHN BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRUCE
Last Name:PERMEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BAY LYN DR
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9405
Mailing Address - Country:US
Mailing Address - Phone:360-354-6800
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA001920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6020OtherDEPT. OF LABOR & INDUST
WA653559OtherACN
WAG8806685OtherMEDICARE ID-TYPE UNSPECIFIED
WA6020OtherDEPT. OF LABOR & INDUST