Provider Demographics
NPI:1356487672
Name:MAFFETONE, PETER JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:MAFFETONE
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 1:3031 LAKEVIEW BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-272-2225
Mailing Address - Fax:
Practice Address - Street 1:10 NW 42ND AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5473
Practice Address - Country:US
Practice Address - Phone:305-476-9106
Practice Address - Fax:305-476-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T84700Medicare UPIN
FL88656Medicare ID - Type Unspecified