Provider Demographics
NPI:1346471257
Name:PETER S. PETROVAS D.C. L.T.D.
Entity Type:Organization
Organization Name:PETER S. PETROVAS D.C. L.T.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:PETROVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:1773-989-4305
Mailing Address - Street 1:5962 N LINCOLN AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3711
Mailing Address - Country:US
Mailing Address - Phone:773-989-4305
Mailing Address - Fax:773-989-7450
Practice Address - Street 1:5962 N LINCOLN AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3711
Practice Address - Country:US
Practice Address - Phone:773-989-4305
Practice Address - Fax:773-989-7450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER S. PETROVAS D.C. L.T.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty