Provider Demographics
NPI:1245714047
Name:PONEMAN, DEANNA (DC)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:PONEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 NW GILMAN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2401
Mailing Address - Country:US
Mailing Address - Phone:425-313-0433
Mailing Address - Fax:
Practice Address - Street 1:355 NW GILMAN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2401
Practice Address - Country:US
Practice Address - Phone:425-313-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60872629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor