MEDICARE: DR. THOMAS JASON PERMENTER 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	2671	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7572054	OTHER	NC	AETNA - PPO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0838F	OTHER	NC	BCBS
4	606834-980061	OTHER	NC	ACN
5	NC3802	OTHER	NC	PREFERRED CHIRO CARE
6	963043003	OTHER	NC	CIGNA
7	2117085094101	OTHER	NC	BEECH STREET
8	56-2215329	OTHER	NC	CNC
9	109362	OTHER	NC	WELLNESS PLAN
10	3467419	OTHER	NC	AETNA - HMO

General Provider Information

NPI Number	:	1164422192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JASON PERMENTER DC

Provider Business Mailing Address
First Line	:	9123 MONROE RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2456
Country	:	US
Telephone Number	:	704-569-3130
Fax Number	:	704-569-9797

Provider Business Practice Location Address
First Line	:	9123 MONROE RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2456
Country	:	US
Telephone Number	:	704-569-3130
Fax Number	:	704-569-9797

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	01/20/2022

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