Provider Demographics
NPI:1851496434
Name:PERMENTER CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PERMENTER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:PERMENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-569-3130
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC963043003OtherCIGNA
NC790838FMedicaid
NC0838FOtherBCBS
NC7572054OtherAETNA - PPO
NC2117085094101OtherBEECH STREET
NC3467419OtherAETNA - HMO
NC606834-980061OtherACN
NCU76101Medicare UPIN