Healthcare Provider Details

I. General information

NPI: 1033193164
Provider Name (Legal Business Name): PETER KEITH CARR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17511 68TH AVENUE NE SUITE 1
KENMORE WA
98028
US

IV. Provider business mailing address

17511 68TH AVENUE NE SUITE # 1
KENMORE WA
98028
US

V. Phone/Fax

Practice location:
  • Phone: 206-724-6760
  • Fax: 206-838-7330
Mailing address:
  • Phone: 206-343-3325
  • Fax: 206-838-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0033993
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: