Provider Demographics
NPI:1538313028
Name:PENNINGTON, CAREY ALLYNN (LAC, LMP)
Entity Type:Individual
Prefix:MR
First Name:CAREY
Middle Name:ALLYNN
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-1300
Mailing Address - Country:US
Mailing Address - Phone:360-205-3085
Mailing Address - Fax:360-275-2007
Practice Address - Street 1:24160 NE STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9626
Practice Address - Country:US
Practice Address - Phone:360-205-3085
Practice Address - Fax:360-275-2007
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60059335171100000X
WAMA00023492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist