Provider Demographics
NPI:1497813851
Name:ZINDT, PENELOPE S (DC)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:S
Last Name:ZINDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:PENELOPE
Other - Middle Name:SUSAN
Other - Last Name:HUTTON ZINDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3819 SO M
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418
Mailing Address - Country:US
Mailing Address - Phone:253-473-2232
Mailing Address - Fax:253-473-2236
Practice Address - Street 1:3819 SO M
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418
Practice Address - Country:US
Practice Address - Phone:253-473-2232
Practice Address - Fax:253-473-2236
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2007961Medicaid
HU3388OtherREGENCE BLUE SHIELD
WA0135215OtherLABOR & INDUSTRIES
WA0276324OtherDEPT OF LABOR & INDUSTRIES
WAG8897650Medicare PIN
WA0276324OtherDEPT OF LABOR & INDUSTRIES
HU3388OtherREGENCE BLUE SHIELD
WA2007961Medicaid