Provider Demographics
NPI:1578965661
Name:PETERS, AMANDA ZEPHYR WILLOW (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ZEPHYR WILLOW
Last Name:PETERS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-9052
Mailing Address - Country:US
Mailing Address - Phone:828-832-6632
Mailing Address - Fax:828-265-0117
Practice Address - Street 1:643 GREENWAY RD STE K1
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4840
Practice Address - Country:US
Practice Address - Phone:828-832-6632
Practice Address - Fax:828-417-3535
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor