Provider Demographics
NPI:1568514602
Name:KEVORKIAN, PETER J (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:KEVORKIAN
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 1:1446 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2743
Mailing Address - Country:US
Mailing Address - Phone:781-769-2500
Mailing Address - Fax:781-255-9727
Practice Address - Street 1:1446 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2743
Practice Address - Country:US
Practice Address - Phone:781-769-2500
Practice Address - Fax:781-255-9727
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35499Medicare ID - Type UnspecifiedPETER KEVORKIAN MEDICARE