Healthcare Provider Details

I. General information

NPI: 1124117684
Provider Name (Legal Business Name): JASON PEPPERD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 MIDWAY AVE
GRAND COULEE WA
99133-5013
US

IV. Provider business mailing address

PO BOX 30
GRAND COULEE WA
99133-0030
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-0861
  • Fax: 509-633-0865
Mailing address:
  • Phone: 509-633-0861
  • Fax: 509-633-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 00034872
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number406
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: