Provider Demographics
NPI:1114079266
Name:BETRAS, PETER T (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:BETRAS
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 1:2860 CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2803
Mailing Address - Country:US
Mailing Address - Phone:330-792-1118
Mailing Address - Fax:330-792-1479
Practice Address - Street 1:2860 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2803
Practice Address - Country:US
Practice Address - Phone:330-792-1118
Practice Address - Fax:330-792-1479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE0454912Medicare ID - Type Unspecified
OHT46989Medicare UPIN