Provider Demographics
NPI:1154433555
Name:PEET, PAULA ELLEN (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ELLEN
Last Name:PEET
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 NE 26TH AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1147
Mailing Address - Country:US
Mailing Address - Phone:954-943-9355
Mailing Address - Fax:954-943-2280
Practice Address - Street 1:2323 NE 26TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1147
Practice Address - Country:US
Practice Address - Phone:954-943-9355
Practice Address - Fax:954-943-2280
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55961Medicare ID - Type Unspecified
55961Medicare UPIN