Provider Demographics
NPI:1124129093
Name:BEGRES, PETER L (D C P C)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:BEGRES
Suffix:
Gender:M
Credentials:D C P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3452
Mailing Address - Country:US
Mailing Address - Phone:906-774-4980
Mailing Address - Fax:906-774-9698
Practice Address - Street 1:918 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3452
Practice Address - Country:US
Practice Address - Phone:906-774-4980
Practice Address - Fax:906-774-9698
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPB005181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM80040001Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
MIT32711Medicare UPIN