Provider Demographics
NPI:1194951038
Name:ANNE PERNICHELE DC PC
Entity type:Organization
Organization Name:ANNE PERNICHELE DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICAIN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PERNICHELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-582-9805
Mailing Address - Street 1:25700 SW ARGYLE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-5799
Mailing Address - Country:US
Mailing Address - Phone:503-582-9805
Mailing Address - Fax:503-582-9795
Practice Address - Street 1:25700 SW ARGYLE AVE STE C
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-5799
Practice Address - Country:US
Practice Address - Phone:503-582-9805
Practice Address - Fax:503-582-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71-3290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty