Provider Demographics
NPI:1124494364
Name:PETERS, THOMAS GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:PETERS
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 1:568 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2933
Mailing Address - Country:US
Mailing Address - Phone:330-337-1441
Mailing Address - Fax:
Practice Address - Street 1:568 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2933
Practice Address - Country:US
Practice Address - Phone:330-337-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011058111N00000X
OHDC04565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
H451300Medicare PIN