Provider Demographics
NPI:1972263663
Name:ST. PETER, ADAM (DC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ST. PETER
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 1:2144 E REPUBLIC RD STE A104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4645
Mailing Address - Country:US
Mailing Address - Phone:417-887-8075
Mailing Address - Fax:417-887-8535
Practice Address - Street 1:2144 E REPUBLIC RD STE A104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4645
Practice Address - Country:US
Practice Address - Phone:417-887-8075
Practice Address - Fax:417-887-8535
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021039474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor