MEDICARE: DR. DOUGLAS HAROLD PEFFER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00002032	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90588	OTHER	WA	WA LABOR & IND.

General Provider Information

NPI Number	:	1033324025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS HAROLD PEFFER DC

Provider Business Mailing Address
First Line	:	26124 PACIFIC HWY S # B
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-6910
Country	:	US
Telephone Number	:	253-941-3088
Fax Number	:	253-941-8458

Provider Business Practice Location Address
First Line	:	26124 PACIFIC HWY S # B
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-6910
Country	:	US
Telephone Number	:	253-941-3088
Fax Number	:	253-941-8458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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