Provider Demographics
NPI:1114119633
Name:LOPEZ, PETER ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:LOPEZ
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 1:8500 WILSHIRE BLVD
Mailing Address - Street 2:PENTHOUSE SUITE
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3121
Mailing Address - Country:US
Mailing Address - Phone:310-652-7721
Mailing Address - Fax:310-652-2616
Practice Address - Street 1:8500 WILSHIRE BLVD
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3121
Practice Address - Country:US
Practice Address - Phone:310-652-7721
Practice Address - Fax:310-652-2616
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor