Active NPI
Jason Pepperd, D.C.
- Chiropractor
- Grand Coulee, WA
National Provider Identifier
1124117684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH 00034872
- Practice address
- 122 Midway Ave
Grand Coulee, WA 99133-5013 - Phone
- (509) 633-0861
- Fax
- (509) 633-0865
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH 00034872 | WA | Primary |
| Chiropractor | 111N00000X | 406 | AK |
Addresses
Primary practice location
122 Midway Ave
Grand Coulee, WA 99133-5013
Mailing address
PO Box 30
Grand Coulee, WA 99133-0030
Phone (509) 633-0861
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CH0406 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH 00034872 | WA | MD | Chiropractor |
| 406 | AK | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505174400000",
"number": "1124117684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30",
"city": "GRAND COULEE",
"state": "WA",
"postal_code": "991330030",
"telephone_number": "509-633-0861",
"fax_number": "509-633-0865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 MIDWAY AVE",
"city": "GRAND COULEE",
"state": "WA",
"postal_code": "991335013",
"telephone_number": "509-633-0861",
"fax_number": "509-633-0865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEPPERD",
"first_name": "JASON",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2017-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH 00034872",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AK",
"license": "406",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CH0406",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Coulee, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.