Provider Demographics
NPI:1033324025
Name:PEFFER, DOUGLAS HAROLD (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HAROLD
Last Name:PEFFER
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 1:26124 PACIFIC HWY S # B
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-6910
Mailing Address - Country:US
Mailing Address - Phone:253-941-3088
Mailing Address - Fax:253-941-8458
Practice Address - Street 1:26124 PACIFIC HWY S # B
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6910
Practice Address - Country:US
Practice Address - Phone:253-941-3088
Practice Address - Fax:253-941-8458
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA90588OtherWA LABOR & IND.
WAPE3773 012105Medicare ID - Type Unspecified