Provider Demographics
NPI:1568603264
Name:PENNER, JOSHUA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LEE
Last Name:PENNER
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 1:5427 17TH AVE NW
Mailing Address - Street 2:#201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3819
Mailing Address - Country:US
Mailing Address - Phone:360-969-0495
Mailing Address - Fax:
Practice Address - Street 1:3150 W GOVERNMENT WAY
Practice Address - Street 2:A-2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1459
Practice Address - Country:US
Practice Address - Phone:206-906-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60067858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor