Provider Demographics
NPI:1598203309
Name:PETERS, BRIAN A JR (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:PETERS
Suffix:JR
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 1:1133 MACARTHUR DR STE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3123
Mailing Address - Country:US
Mailing Address - Phone:318-561-6250
Mailing Address - Fax:318-561-6252
Practice Address - Street 1:1133 MACARTHUR DR STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3123
Practice Address - Country:US
Practice Address - Phone:318-561-6250
Practice Address - Fax:618-561-6252
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor