Provider Demographics
NPI:1437816360
Name:JEREMICH, PETER MILES (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MILES
Last Name:JEREMICH
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 1:245 MAIN ST STE 2M
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2007
Mailing Address - Country:US
Mailing Address - Phone:732-583-0600
Mailing Address - Fax:
Practice Address - Street 1:245 MAIN ST STE 2M
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2007
Practice Address - Country:US
Practice Address - Phone:732-583-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00785300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor