Provider Demographics
NPI:1215137625
Name:PETER L BEGRES P C
Entity type:Organization
Organization Name:PETER L BEGRES P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BEGRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:906-774-4980
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M80040Medicare PIN