Provider Demographics
NPI:1528022449
Name:MUDAR, PETER J (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:MUDAR
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 1:3275 LEECHBURG RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2858
Mailing Address - Country:US
Mailing Address - Phone:724-337-4454
Mailing Address - Fax:724-337-4401
Practice Address - Street 1:3275 LEECHBURG RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-2858
Practice Address - Country:US
Practice Address - Phone:724-337-4454
Practice Address - Fax:724-337-4401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003156L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMU07700Medicare ID - Type Unspecified
PAU11540Medicare UPIN