Provider Demographics
NPI:1164422192
Name:PERMENTER, THOMAS JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JASON
Last Name:PERMENTER
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 1:9123 MONROE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2456
Mailing Address - Country:US
Mailing Address - Phone:704-569-3130
Mailing Address - Fax:704-569-9797
Practice Address - Street 1:9123 MONROE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2456
Practice Address - Country:US
Practice Address - Phone:704-569-3130
Practice Address - Fax:704-569-9797
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7572054OtherAETNA - PPO
NC790838FMedicaid
NC0838FOtherBCBS
NC606834-980061OtherACN
NCNC3802OtherPREFERRED CHIRO CARE
NC963043003OtherCIGNA
NC2117085094101OtherBEECH STREET
NC56-2215329OtherCNC
NC109362OtherWELLNESS PLAN
NC3467419OtherAETNA - HMO
NC963043003OtherCIGNA
NCU76101Medicare UPIN