Provider Demographics
NPI:1376153130
Name:PETERS, KACI (DIPL AC)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7716
Mailing Address - Country:US
Mailing Address - Phone:307-689-1120
Mailing Address - Fax:
Practice Address - Street 1:1602 MOUNTAIN VIEW RD STE 102
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4391
Practice Address - Country:US
Practice Address - Phone:605-719-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist