Provider Demographics
NPI:1598918195
Name:PETERS CHIROPRACTIC PC
Entity type:Organization
Organization Name:PETERS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-335-7011
Mailing Address - Street 1:125 S BROADVIEW ST STE 14
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5744
Mailing Address - Country:US
Mailing Address - Phone:573-335-7011
Mailing Address - Fax:573-335-8836
Practice Address - Street 1:125 S BROADVIEW ST STE 14
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5744
Practice Address - Country:US
Practice Address - Phone:573-335-7011
Practice Address - Fax:573-335-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty