Provider Demographics
NPI:1235541160
Name:PEET, COURTNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:PEET
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CENTER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4046
Mailing Address - Country:US
Mailing Address - Phone:802-772-4377
Mailing Address - Fax:
Practice Address - Street 1:73 CENTER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4046
Practice Address - Country:US
Practice Address - Phone:802-735-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060101820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023261Medicaid