Provider Demographics
NPI:1982708376
Name:CHANGARIS, PETER JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:CHANGARIS
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 1:3720 GRASS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602
Mailing Address - Country:US
Mailing Address - Phone:916-717-4133
Mailing Address - Fax:530-673-9148
Practice Address - Street 1:3720 GRASS VALLEY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602
Practice Address - Country:US
Practice Address - Phone:916-717-4133
Practice Address - Fax:530-673-9148
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA68-0033842OtherTAX ID NUMBER
CADC0134820Medicare ID - Type Unspecified
CATO5037Medicare UPIN