MEDICARE: DR. JOSHUA LEE PENNER D.C.

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	CH60067858	WA

General Provider Information

NPI Number	:	1568603264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA LEE PENNER D.C.

Provider Business Mailing Address
First Line	:	5427 17TH AVE NW
Second Line	:	#201
City	:	SEATTLE
State	:	WA
Zip	:	98107-3819
Country	:	US
Telephone Number	:	360-969-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 W GOVERNMENT WAY
Second Line	:	A-2
City	:	SEATTLE
State	:	WA
Zip	:	98199-1459
Country	:	US
Telephone Number	:	206-906-9239
Fax Number	:

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/11/2010

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