Provider Demographics
NPI:1386838902
Name:REDMOND, PETER DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DEAN
Last Name:REDMOND
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-0940
Mailing Address - Country:US
Mailing Address - Phone:610-524-2171
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST FL 30
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6207
Practice Address - Country:US
Practice Address - Phone:215-735-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006411L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADC006411OtherLICENSE NUMBER