Provider Demographics
NPI:1558508762
Name:PETERHANS DC LLC
Entity Type:Organization
Organization Name:PETERHANS DC LLC
Other - Org Name:PETERHANS-RITT CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERHANS-RITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:989-684-8400
Mailing Address - Street 1:1407 S. EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3380
Mailing Address - Country:US
Mailing Address - Phone:989-684-8400
Mailing Address - Fax:989-684-8404
Practice Address - Street 1:1407 S. EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3380
Practice Address - Country:US
Practice Address - Phone:989-684-8400
Practice Address - Fax:989-684-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MI2301009393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P50930Medicare UPIN
MIOP50930Medicare PIN