Provider Demographics
NPI:1962087080
Name:PELTIER, STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PELTIER
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 1:1023 DWANE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1645
Mailing Address - Country:US
Mailing Address - Phone:612-751-2290
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S STE 220
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4762
Practice Address - Country:US
Practice Address - Phone:612-200-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor