| Organization Name: | PENINSULA PAIN RELIEF CENTER |
| NPI Number: | 1497193650 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARRY MIGGINS (PRESIDENT/OWNER) |
| Mailing Address: | 5050 State Highway 303 Ne Suite A101 Bremerton |
| State: | WA US |
| Postal Code: | 983113629 |
| Phone Number: | 3604789788 |
| Fax Number: | 3604056255 |
| NPI Enumeration Date: | 06/10/2013 |
| NPI Last Update Date: | 07/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |