Provider Demographics
NPI:1528175924
Name:PETERS, GARY W (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:PETERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:807 N SULLIVAN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8546
Mailing Address - Country:US
Mailing Address - Phone:509-924-0504
Mailing Address - Fax:509-340-3732
Practice Address - Street 1:807 N SULLIVAN RD
Practice Address - Street 2:STE 1
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8546
Practice Address - Country:US
Practice Address - Phone:509-924-0504
Practice Address - Fax:509-340-3732
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WACH00034543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA203364OtherLABOR & INDUSTRIES
WA8862PEOtherASURIS
WAT17557Medicare UPIN
WAG8857116Medicare PIN