Provider Demographics
NPI:1134127186
Name:PETER, GREGORY D (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name: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 1:901 NORMAL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-3770
Mailing Address - Country:US
Mailing Address - Phone:936-291-2111
Mailing Address - Fax:936-291-0665
Practice Address - Street 1:901 NORMAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3770
Practice Address - Country:US
Practice Address - Phone:936-291-2111
Practice Address - Fax:936-291-0665
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06009127Medicaid
TX600912OtherBCBS PROVIDER NUMBER
TXC06009127Medicaid