Provider Demographics
NPI:1033193164
Name:CARR, PETER KEITH (DC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:KEITH
Last Name:CARR
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 1:17511 68TH AVENUE NE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028
Mailing Address - Country:US
Mailing Address - Phone:206-343-3325
Mailing Address - Fax:206-838-7330
Practice Address - Street 1:17511 68TH AVENUE NE
Practice Address - Street 2:SUITE 1
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:206-724-6760
Practice Address - Fax:206-838-7330
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0033993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor