Provider Demographics
NPI:1679587315
Name:CARPENTER, PENELOPE ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:ANNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:ANNE
Other - Last Name:MARICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3713 RUCKER #1
Mailing Address - Street 2:CARPENTER CHIROPRACTIC CENTER
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4632
Mailing Address - Country:US
Mailing Address - Phone:425-258-1300
Mailing Address - Fax:425-259-7240
Practice Address - Street 1:3713 RUCKER #1
Practice Address - Street 2:CARPENTER CHIROPRACTIC CENTER
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4632
Practice Address - Country:US
Practice Address - Phone:425-258-1300
Practice Address - Fax:425-259-7240
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1478111N00000X
MO4416111N00000X
OK2069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02959Medicare UPIN