Provider Demographics
NPI:1124117684
Name:PEPPERD, JASON (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:PEPPERD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:GRAND COULEE
Mailing Address - State:WA
Mailing Address - Zip Code:99133-0030
Mailing Address - Country:US
Mailing Address - Phone:509-633-0861
Mailing Address - Fax:509-633-0865
Practice Address - Street 1:122 MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-5013
Practice Address - Country:US
Practice Address - Phone:509-633-0861
Practice Address - Fax:509-633-0865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 00034872111N00000X
AK406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0406Medicaid
AK152624Medicare ID - Type UnspecifiedGROUP
AKCH0406Medicaid