Provider Demographics
NPI:1093822314
Name:PETERS, J. CHRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:CHRIS
Last Name:PETERS
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 1:78467 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2076
Mailing Address - Country:US
Mailing Address - Phone:760-564-8400
Mailing Address - Fax:760-771-6030
Practice Address - Street 1:78467 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2076
Practice Address - Country:US
Practice Address - Phone:760-564-8400
Practice Address - Fax:760-771-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24931OtherLICENSE #
CADC0249310Medicare ID - Type UnspecifiedMEDICARE PROVIDER #