Provider Demographics
NPI:1295980076
Name:PERNICHELE, ANNE ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELIZABETH
Last Name:PERNICHELE
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 1:1250 SUNNINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-1739
Mailing Address - Country:US
Mailing Address - Phone:503-805-9183
Mailing Address - Fax:503-635-2415
Practice Address - Street 1:1250 SUNNINGDALE RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-1739
Practice Address - Country:US
Practice Address - Phone:503-805-9183
Practice Address - Fax:503-635-2415
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3290111NP0017X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education